Diagnostic Considerations

Other problems to be considered with notalgia paresthetica (NP) include neurodermatitis, other primary pruritus, atypical brachioradial pruritus (BRP), and other localized pruritus syndromes. In particular, consideration must be given to cervical and lumbar spine disease. Additional radiographic studies may be warranted to further assess possible underlying cervical spine disease.

Differential Diagnoses

Workup

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Media Gallery

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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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 Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

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.