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Notalgia Paresthetica Medication

  • Author: Ally N Alai, MD, FAAD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Apr 29, 2016
 

Medication Summary

While no uniformly effective topical treatment has been reported for the cutaneous symptoms of notalgia paresthetica (NP), common first-line dermatologic medications have typically included potent topical steroid creams and topical antipruritics like capsaicin. Currently available therapeutic options for the localized itch syndromes include capsaicin cream,[18] eutectic mixture of local anesthetic (EMLA) cream, topical steroids, pramoxine cream, topical cooling or ice pack applications, oral steroids, Tiger balm, camphor and menthol creams, flurandrenolide tape (Cordran Tape), intralesional corticosteroid injections, botulinum toxin injections,[17] oral antihistamines, hydroxyzine, doxepin, topiramate (Topamax), anticonvulsant medications, carbamazepine (Tegretol), antidepressant medications, gabapentin (Neurontin), oxcarbazepine,[19] and thalidomide.[20]

Some of the current systemic therapies may exert their effect through the spinal nerves and central nervous system, thereby supporting the neuropathic etiology of notalgia paresthetica.[4, 11]

Second-line therapy for notalgia paresthetica includes medications such as oral nonsteroidal anti-inflammatory medications (eg, ibuprofen, celecoxib, ketorolac) and oral muscle relaxants (eg, carisoprodol, cyclobenzaprine, methocarbamol, metaxalone).

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Topical corticosteroid (very high potency)

Clobetasol propionate (Temovate, Clobex, Cormax)

 

Clobetasol propionate is a class I superpotent topical steroid; it suppresses mitosis and increases the synthesis of proteins that decrease inflammation and cause vasoconstriction. Clobetasol propionate decreases inflammation by stabilizing lysosomal membranes, inhibiting PMN and mast cell degranulation.

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Topical corticosteroid (high potency)

Fluocinonide (Lidex)

 

Fluocinonide is a high-potency steroid that inhibits cell proliferation. It is immunosuppressive, antiproliferative, and anti-inflammatory. Fluocinonide also has antipruritic and vasoconstrictive properties.

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Topical corticosteroid (medium potency)

Triamcinolone topical (Aristacort)

 

Triamcinolone topical is used for inflammatory dermatosis responsive to steroids; it decreases inflammation by suppressing the migration of PMNs and reversing capillary permeability. It is available in ointment (0.1%) and cream (0.025%, 0.1%, 0.5%).

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Antipruritic

Hydroxyzine hydrochloride (Atarax, Vistaril)

 

Hydroxyzine hydrochloride antagonizes H1 receptors in the periphery. It may suppress histamine activity in the subcortical region of CNS.

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Topical analgesic

Capsaicin topical (Capzasin-P and Zostrix)

 

Capsaicin is a natural chemical derived from plants of the Solanaceae family. It penetrates deep for temporary relief of minor aches and pains of muscles and joints associated inflammatory reactions. Capsaicin may render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons. It has demonstrated effectiveness in several studies of diabetic neuropathic pain and in other types of neuropathic pain.

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Contributor Information and Disclosures
Author

Ally N Alai, MD, FAAD Medical Director, The Skin Center at Laguna; Former Professor, Department of Dermatology, Clinical Faculty and Preceptor, Department of Family Practice, University of California, Irvine, School of Medicine; Former Professor and Preceptor, Department of Family Practice Residency Training, Downey Medical Center; Expert Medical Reviewer, Medical Board of California; Expert Consultant, California Department of Consumer Affairs; Expert Reviewer, California Department of Registered Nursing

Ally N Alai, MD, FAAD is a member of the following medical societies: American Academy of Dermatology, American Society for MOHS Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Daniel J Hogan, MD Clinical Professor of Internal Medicine (Dermatology), Nova Southeastern University College of Osteopathic Medicine; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, Canadian Dermatology Association

Disclosure: Nothing to disclose.

Acknowledgements

Dena Thompson, MS Boston University School of Medicine

Disclosure: Nothing to disclose.

Acknowledgments

We would like to acknowledge our appreciation for clinical photographs and study provided by The Skin Center at Laguna in Laguna Hills, California.

References
  1. Alai NN, Skinner HB, Nabili ST, Jeffes E, Shahrokni S, Saemi AM. Notalgia paresthetica associated with cervical spinal stenosis and cervicothoracic disk disease at C4 through C7. Cutis. 2010 Feb. 85(2):77-81. [Medline].

  2. Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease: Neurocutaneous dysesthesias. J Am Acad Dermatol. 2016 Feb. 74 (2):215-28. [Medline].

  3. Thornsberry LA, English JC 3rd. Scalp dysesthesia related to cervical spine disease. JAMA Dermatol. 2013 Feb. 149(2):200-3. [Medline].

  4. Bernard PA, Wayne ME. Notalgia paresthetica. Neurology. 1978. 28:1310-.

  5. Springall DR, Karanth SS, Kirkham N, Darley CR, Polak JM. Symptoms of notalgia paresthetica may be explained by increased dermal innervation. J Invest Dermatol. 1991 Sep. 97(3):555-61. [Medline].

  6. Eisenberg E, Barmeir E, Bergman R. Notalgia paresthetica associated with nerve root impingement. J Am Acad Dermatol. 1997 Dec. 37(6):998-1000. [Medline].

  7. Alai NN, Skinner HB, Nabili ST, Jeffes E, Shahrokni S, Saemi AM. Notalgia paresthetica associated with cervical spinal stenosis and cervicothoracic disk disease at C4 through C7. Cutis. 2010 Feb. 85 (2):77-81. [Medline].

  8. Savk E, Savk SO. On brachioradial pruritus and notalgia paresthetica. J Am Acad Dermatol. 2004 May. 50 (5):800-1. [Medline].

  9. Weber PJ, Poulos EG. Notalgia paresthetica. Case reports and histologic appraisal. J Am Acad Dermatol. 1988 Jan. 18(1 Pt 1):25-30. [Medline].

  10. Goodkin R, Wingard E, Bernhard JD. Brachioradial pruritus: cervical spine disease and neurogenic/neuropathic [corrected] pruritus. J Am Acad Dermatol. 2003 Apr. 48(4):521-4. [Medline].

  11. Savk O, Savk E. Investigation of spinal pathology in notalgia paresthetica. J Am Acad Dermatol. 2005 Jun. 52(6):1085-7. [Medline].

  12. Maciel AA, Cunha PR, Laraia IO, Trevisan F. Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica. An Bras Dermatol. 2014 Jul-Aug. 89 (4):570-5. [Medline]. [Full Text].

  13. Tait CP, Grigg E, Quirk CJ. Brachioradial pruritus and cervical spine manipulation. Australas J Dermatol. 1998 Aug. 39(3):168-70. [Medline].

  14. Savk E, Savk O, Sendur F. Transcutaneous electrical nerve stimulation offers partial relief in notalgia paresthetica patients with a relevant spinal pathology. J Dermatol. 2007 May. 34(5):315-9. [Medline].

  15. Yosipovitch G, Samuel LS. Neuropathic and psychogenic itch. Dermatol Ther. 2008 Jan-Feb. 21(1):32-41. [Medline].

  16. Stellon A. Neurogenic pruritus: an unrecognised problem? A retrospective case series of treatment by acupuncture. Acupunct Med. 2002 Dec. 20(4):186-90. [Medline].

  17. Weinfeld PK. Successful treatment of notalgia paresthetica with botulinum toxin type A. Arch Dermatol. 2007 Aug. 143(8):980-2. [Medline].

  18. Goodless DR, Eaglstein WH. Brachioradial pruritus: treatment with topical capsaicin. J Am Acad Dermatol. 1993 Nov. 29 (5 Pt 1):783-4. [Medline].

  19. Savk E, Bolukbasi O, Akyol A, Karaman G. Open pilot study on oxcarbazepine for the treatment of notalgia paresthetica. J Am Acad Dermatol. 2001 Oct. 45(4):630-2. [Medline].

  20. Pereira J. Brachioradial pruritus treated with thalidomide. An Bras Dermatol. 2005. 80:295-6.

 
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Cervical spine MRI demonstrating cervical disk disease and multilevel degenerative changes from C4-C5 through C7-T1. Note multiple osteophyte complexes and small disk bulges. Courtesy of Dr. Nili Alai, The Skin Center at Laguna.
Mildly hyperpigmented skin of right infrascapular back. Courtesy of Dr. Nili Alai, The Skin Center at Laguna.
MRI of the cervical spine demonstrating disc bulges at C5-C6. Courtesy of Dr. Nili Alai, The Skin Center at Laguna.
Refractory notalgia mid-back in female who later developed systemic lymphoma. Courtesy of Dr. Nili Alai, The Skin Center at Laguna.
Atypical Notalgia Paresthetica Low Back: Zosteriform erosions in appearance but lesions cross midline. Courtesy of Dr. Nili Alai, The Skin Center at Laguna.
 
 
 
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