Notalgia paresthetica: clinical features, radiological evaluation, and a novel therapeutic option

Abstract

Background/objective Notalgia paresthetica (NP) is a sensory neuropathy characterized by localized pruritus and pain, presenting with or without a well-circumscribed hyperpigmented patch in the upper back. Abnormal sensations, such as burning, numbness, and paresthesia are often present in patients with NP. In this study, we clinically and radiologically analyzed patients with NP. The literature contains studies describing lidocaine treatments involving intravenous and topical applications for NP. We also investigated the effect of intradermal lidocaine injection on patients with NP. Methods A total of 80 patients (45 patients with NP and 35 suffering from dorsalgia without NP) were included in the study. The age, gender and body mass index (BMI) of the patients, and the characteristics of their symptoms were recorded. The severity of pain and pruritus was assessed by the Visual Analog Scale (VAS). Radiography and magnetic resonance imaging of the spine were performed. In this study, we intradermally administered lidocaine diluted with saline into the upper back over three sessions. 1 cc 2% lidocaine was diluted with 5 cc 0.9% saline, and a total of 6 cc lidocaine mixture was obtained. The injection was performed locally at 1-cm intervals around the hyperpigmented patch and segmentally along the C2-T6 spinous processes. These patients were called for a follow-up at the second and fourth weeks and third month. Results There was no statistically significant difference between the two groups in terms of age, BMI, VAS-pain score, and duration of symptoms (p > 0.05 for all). Forty-six cervical and/or thoracic degenerative changes or herniated nucleus pulposus (HNP) were detected in patients with NP. There was a significantly higher number of HNP at the C6–7 segment and cervical degenerative changes in the NP group (p < 0.05). The VAS-pain and VAS-pruritus scores were significantly decreased at all follow-up sessions, and improvement was sustained by lidocaine up to the third month. Conclusion Cervical degenerative changes and HNP of the C6–7 segment seem to be contributing factors for NP. Local lidocaine can be effective for pain relief and pruritus in NP.

Understanding the patient experience of living with notalgia paresthetica: A qualitative interview study

“…The findings of this study confirm that itch is the most common symptom experienced by patients living with NP, 15 that it may last for many years, 1 and that, in addition to chronic pruritus, symptoms include burning or cold sensations, tingling, numbness, paresthesia, tenderness, or foreign body sensation. 2 , 4 This study also showed that despite the available treatments, NP-associated itch and other symptoms of NP have a great impact on the daily lives of patients.…”

“… 1 , 2 , 3 In addition to chronic itch, patients with NP may experience burning or cold sensations, surface numbness, tingling, paresthesia, foreign body sensation, or tenderness. 2 , 4 NP is thought to be caused by damage to the thoracic nerves, 2 most frequently from vertebrae degeneration and disc herniation, although it remains unclear whether the damage is peripheral or radicular. 2 , 5 A recent case series of 117 patients with NP confirmed that the disease mostly affects middle-aged women and found that the intensity of pruritus did not differ by age, sex, skin type, or comorbidities.…”

Notalgia paresthetica: An unknown condition by doctors

“…Notalgia paresthetica (NP) is a little-known condition, with characteristic symptoms that can be described by the patient and observed on physical examination. The most common complaints are the presence of pruritus in the dorsal region, hyperpigmentation, hypopigmentation centrally located in the affected region and referred pain with the characteristics of neuropathic pain [1,2]. It usually affects the dorsal region, being located between the vertebrae T2 and T6 [1][2][3][4].…”

“…The most common complaints are the presence of pruritus in the dorsal region, hyperpigmentation, hypopigmentation centrally located in the affected region and referred pain with the characteristics of neuropathic pain [1,2]. It usually affects the dorsal region, being located between the vertebrae T2 and T6 [1][2][3][4]. In diagnostic investigation, imaging tests such as radiography and magnetic resonance imaging of the dorsal spine, and electromyography can be performed, aiming to identify vertebral degenerations that affect nerve roots [3].…”

“…Diagnostic and therapeutic alternatives have been investigated by several specialists, a study developed by Mülkoğlu et al (2020) [1], reported the intradermal application of lidocaine in patients with NP, thus with varied results, but some with positive responses, resulting in partial or total resolution of the pruritus, another promising therapeutic proposal is the application of intradermal botulinum toxin type A (BTX-A), described by Pérez-Pérez et al (2013) [2]. BTX-A inhibits the release of substance P resulting in a significant improvement in the itching induced by the release of histamine in the affected region.…”