Notalgia paresthetica: treatment with topical tacrolimus

Ochi, Harumi; Tan, LT; Tey, Hong Liang

doi:10.1111/jdv.12830

Cited by 21 publications

(13 citation statements)

References 7 publications

(4 reference statements)

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“…Five experienced reduced intensity and frequency of itch after this period of therapy. It is hypothesized that the mechanism of action for the topical application of this immunosuppressive medication is via activation of transient receptor potential cation channels on peripheral nerve fibers thus decreasing pruritic signals being transmitted …”

Section: Discussionmentioning

confidence: 99%

Notalgia paresthetica: a review for dermatologists

Howard

Sahhar

Andrews³

et al. 2017

Int J Dermatology

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Notalgia paresthetica (NP) is an underdiagnosed condition that presents with unilateral pruritus medial to the scapula on the midback with or without an associated hyperpigmented or hypopigmented macule. There is a paucity of recent reviews on this chronic cutaneous neuropathy in peer-reviewed journals. Current theories propose the condition is likely multifactorial, including spinal entrapment and muscular compressive neuropathy. An extensive literature review was performed by searching the MEDLINE database to review all published works on notalgia paresthetica. This review will provide a useful update for clinicians on the pathogenesis, clinical features, biopsy features, risk factors, and management options for this condition including pharmacological and nonpharmacological methods detailing published treatment options to date for this difficult to treat condition.

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Section: Discussionmentioning

confidence: 99%

Notalgia paresthetica: a review for dermatologists

Howard

Sahhar

Andrews³

et al. 2017

Int J Dermatology

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“…Our patient presented with the typical clinical features of MP and a supportive history of recent bariatric surgery. The use of topical tacrolimus has not been previously reported in MP, but it has been reported in another neuropathic itch, notalgia paresthetica, and its antipruritic effect has been reported in atopic dermatitis, as well as in a few chronic pruritic conditions . The exact mechanism of action of topical tacrolimus in MP is not known, but it is believed to have a capsaicin‐like effect and may mediate its antipruritic effect through activation of the transient receptor potential vanilloid 1 (TRPV1) located on peripheral nerve fibers .…”

Section: Discussionmentioning

confidence: 99%

Meralgia paresthetica successfully treated with topical 0.1% tacrolimus: a case report

Grönhagen

Tey

2015

Int J Dermatology

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“…1 Case reports have shown variable improvement of itch with topical capsaicin 6 , lidocaine, and prilocaine topical cream (Emla cream) 7 , tacrolimus ointment 8 , cutaneous botulinum toxin type A injection 9 , local paravertebral nerve block 10 , transcutaneous electric nerve stimulation 11,12 , surgical nerve decompression 13 , epidural steroid injections, and UVB light treatments 14 ; and with the drugs gabapentin 15 , oxycarbazepine 7 , amitriptyline 16 , and phenytoin. 1 However, these treatments are typically temporary, invasive, or expensive, or have potential side effects.…”

Section: Discussionmentioning

confidence: 99%

Notalgia Paresthetica Relieved by Cervical Traction

Low

Swanson

2017

J Am Board Fam Med

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Notalgia paresthetica is a syndrome of unilateral, chronic pruritis that is associated with burning pain, paresthesia, numbness, and hyperesthesia localized to the medial and inferior scapula. The condition does not respond to anti-inflammatory drugs or traditional antipruritic agents and has variable responses to numerous other reported pharmacologic and nonpharmacologic therapies. Although the etiology is thought to be nerve impingement, neurologic and musculoskeletal causes are often not considered in the differential diagnosis. We present a report of a woman with a 2-year history of refractory notalgia paresthetica. Notalgia paresthetica, first described in 1934, is a unilateral pruritus located medial or inferior to the scapula.1 Burning pain, paresthesia, numbness, and hyperesthesia may accompany the itch. 2 The condition is more prevalent in middle-aged women and is often chronic, lasting for years. 1 The condition is similar to other forms of neuropathic itch or neurocutaneous dysesthesias, such as meralgia paresthetica and brachioradialis syndrome. Notalgia paresthetica is not believed to be rare, although it is not frequently reported or studied. 3 A number of physical and pharmacologic therapies have been described, with variable results. Herein, we report a case of notalgia paresthetica that responded to cervical traction with permanent resolution of symptoms. Case ReportA 49-year-old woman presented with a 2-year history of increasing pruritus and skin sensitivity. She had a history of atopy and initially attributed the cause of the condition to a clothing allergy. The pruritus was localized to the left midscapular region, extending to the posterior and medial upper arm and axilla. The itch was present most of the day, occasionally wakening her from sleep at night, and was aggravated by hot weather and hot showers. Topical corticosteroid, ketamine, lidocaine, and menthol therapies provided only temporary relief. On examination, there was slight hyperesthesia of the involved skin and a few excoriations but no evidence of dermatitis, induration, warmth, or swelling. A punch biopsy of the involved skin showed no pathologic findings. A computed tomographic scan of the patient's cervical spine revealed a small C5-C6 central disk herniation, not impacting the thecal sac. At the C7-T1 level, there was a mild to moderate, left-sided bony neuroforaminal stenosis with a possible C8 root compromise.The patient was prescribed a 6-week course of cervical mechanical traction of the C4 -C7 vertebrae and exercises to release the left upper trapezius and posterior shoulder capsule and to strengthen the lower trapezius, as well as posture education.

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Notalgia paresthetica: treatment with topical tacrolimus

Cited by 21 publications

References 7 publications

Notalgia paresthetica: a review for dermatologists

Notalgia paresthetica: a review for dermatologists

Meralgia paresthetica successfully treated with topical 0.1% tacrolimus: a case report

Notalgia Paresthetica Relieved by Cervical Traction

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