Notalgia paresthetica is not a disease but is a common condition that produces sudden change in sensation of the skin region located below the shoulder blade or mid back region. This condition is often under-recognized and is sometimes felt with pain or altered sensation. The skin surface on this area can change its normal color due to repeated scratching or sometimes causing colored mark on the skin. It can be also described as sensory neuropathic syndrome affecting the mid back region.
Change in the normal sensation of skin area below the shoulder blade is noted when tested with heat or pinprick. Exact cause of notalgia paresthetica is not known. Mild form of skin pigmentation can be treated with local anesthetic creams and sensory correction can also be done. In severe cases of cervical spasms surgery is done.
Symptoms :
Signs and symptoms are not noted for notalgia paresthetica. Itchy feeling with pain is felt on the mid back skin region. For some people, it can cause burning pain and tenderness due to the development of hyperpigmented patches in the skin. Small circular patches like eczema and secondary skin infections may develop in some cases. The patient may not be able to feel the sensation of heat or cold or even sweat on this area due to localized tanning of skin. The condition of NP can become chronic (persistent) in most of the cases. There would be period of remissions (without any symptoms) followed by flaring. It would be a nuisance and discomfort for the affected person.
Cause :
Exact causative factor of NP is not clearly understood. It is believed to develop due to back injury and over exposure of skin to harsh sunlight. It can also be caused by neuropathy caused by degenerative disk disease or nerve impingement. For some people NP is caused as side effect after shingles. Nerve injury is quite common in the mid back region since they are vulnerable. NP cannot be considered as a skin disease alone but it indicates weakness in the underlying spine possibly due to degenerative cervical spine.
Diagnosis :
Visual symptoms provide cue to the doctor about Notalgia paresthetica. No lab tests are needed but your doctor may request for simple pruritus workup. In case he suspects underlying spine injury he may order for imaging tests like CT or MRI scan which would be useful in getting a clear picture. Patients with a history of cervical spine disease or mild nerve injury should get a Magnetic Resonance scan.
Notalgia Paresthetica Treatment :
Depending on the symptoms and skin pigments your doctor may suggest cooling lotions and local anesthetic creams. Capsaicin cream is effective in reducing the chemical transmitters of nerve endings. Topical steroids like temovate or clobex is recommended for severe skin pigmentation. In other cases medium potency drugs like triaminolone or fluocinonide or antipruritic creams like Atarax or vistaril are given. Oral antihistamines can be taken to control itching. For some people, doctor may prescribe anticonvulsant drugs like Tegretol and antidepressant drugs for getting comfort.
Electrical nerve stimulation can be done to repair the sensation of nerve endings in the mid back. Botox injection can be given to reduce pain and itchy feeling of the skin. Surgery is the option for patients diagnosed with cervical disease. Non invasive procedures like laparoscopic disc repair or disc replacement is done. Alternative treatments like acupuncture and chiropractic therapy is also useful in managing the symptoms of notalgia paresthetica.
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