Notalgia Paraesthetica

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Notalgia paresthetica (NP) is a chronic cutaneous sensory neuropathy that causes localized alloknesis and associated dysesthesias, such as pain, numbness, and tingling in the thoracic spine.


The precise pathophysiology underlying NP is yet to be fully elucidated. However, a prominent hypothesis suggests that degenerative changes in the spine or musculoskeletal compression leads to impingement of the posterior cutaneous branches of T2-T6 spinal nerves, which subsequently causes a thoracic polyradiculopathy and contributes to the pathogenesis of NP. It is believed that this impingement results in damage to the spinal nerves mentioned above. Patients with NP are more likely to have degenerative cervical and thoracic spine disease than those with back pain without pruritis[1]

It can also occur in small fibre neuropathy.


The condition has a predilection for those in their middle age and affects women 2 to 3 times more often than men.[1]

Clinical Features

This condition is characterized by hyperpigmentation and chronic scratching and rubbing in the thoracic spine. Typically, the symptoms are unilateral and located in the middle or upper back, medial or inferior to the scapula between T2 to T6.

NP can last for years, with periods of remission and exacerbation. It primarily affects adults, especially women, but hereditary cases have also been reported in younger patients associated with multiple endocrine neoplasia type 2A (MEN 2A).


The following have been proposed.[2][3] Capsaicin seems to have the most research evidence.

Topical agents: capsaicin, tacrolimus, anesthetic cream, and amitriptyline/ketamine

Systemic agents: gabapentin, oxcarbazepine, and TCAs

Procedures: botulinum toxin A and narrowband UVB, and physical therapy.

Other: Exercise, TENS



  1. 1.0 1.1 Robinson, Christopher; Downs, Evan; De la Caridad Gomez, Yanet; Nduaguba, Chinonso; Woolley, Parker; Varrassi, Giustino; Gill, Jatinder; Simopoulos, Thomas T.; Viswanath, Omar; Yazdi, Cyrus A. (2023-02-19). "Notalgia Paresthetica Review: Update on Presentation, Pathophysiology, and Treatment". Clinics and Practice. 13 (1): 315–325. doi:10.3390/clinpract13010029. ISSN 2039-7275. PMC 9955802. PMID 36826171.
  2. Ansari, Ahmed; Weinstein, David; Sami, Naveed (2020-05-18). "Notalgia paresthetica: treatment review and algorithmic approach". Journal of Dermatological Treatment. 31 (4): 424–432. doi:10.1080/09546634.2019.1603360. ISSN 0954-6634. PMID 30942103.
  3. Howard, Matthew; Sahhar, Lukas; Andrews, Frank; Bergman, Ralph; Gin, Douglas (2018-04). "Notalgia paresthetica: a review for dermatologists". International Journal of Dermatology. 57 (4): 388–392. doi:10.1111/ijd.13853. ISSN 1365-4632. PMID 29243804. Check date values in: |date= (help)

Literature Review