Laboratory Studies

Laboratory tests are generally not required in the evaluation of notalgia paresthetica (NP).

Imaging Studies

Although imaging tests have traditionally not been a part of the workup of notalgia paresthetica (NP), basic cervical and possibly thoracic radiographs or MRI may be warranted in the initial management of the disorder. Imaging studies may be particularly helpful in patients with contributory spine symptoms of pain, tenderness, spasm, or decreased range of motion and any history of spinal trauma or injury.^[15]Note the MRI in the image below.

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.

View Media Gallery

Histologic Findings

Skin biopsy and tissue histology are usually not indicated for the diagnosis of notalgia paresthetica (NP). Biopsies may be performed to exclude other diagnoses and neoplasms. No criteria for tissue diagnosis of notalgia paresthetica are described, but some believe the macular amyloidosis of the mid back is part of the spectrum of notalgia paresthetica. Published studies have shown various histologic findings, including, postinflammatory hyperpigmentation and localized amyloid.^[13]

Treatment & Management

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. [QxMD MEDLINE Link].
Chiriac A, Podoleanu C, Moldovan C, Stolnicu S. Notalgia Paresthetica, A Clinical Series and Review. Pain Pract. 2016 Jun. 16 (5):E90-1. [QxMD MEDLINE Link].
Thornsberry LA, English JC 3rd. Scalp dysesthesia related to cervical spine disease. JAMA Dermatol. 2013 Feb. 149(2):200-3. [QxMD MEDLINE Link].
Alai NN, Skinner HB. Concurrent notalgia paresthetica and brachioradial pruritus associated with cervical degenerative disc disease. Cutis. 2018 Sep. 102 (3):185;186;189;190. [QxMD MEDLINE Link]. [Full Text].
Alai NN. What Caused This Refractory Unilateral Pruritic Hyperpigmented Eruption?. The Dermatologist. Available at https://www.the-dermatologist.com/article/what-caused-refractory-unilateral-pruritic-hyperpigmented-eruption?page=1. January 2020; Accessed: February 20, 2020.
Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease: Neurocutaneous dysesthesias. J Am Acad Dermatol. 2016 Feb. 74 (2):215-28. [QxMD MEDLINE Link].
Howard M, Sahhar L, Andrews F, Bergman R, Gin D. Notalgia paresthetica: a review for dermatologists. Int J Dermatol. 2018 Apr. 57 (4):388-392. [QxMD MEDLINE Link].
Bernard PA, Wayne ME. Notalgia paresthetica. Neurology. 1978. 28:1310-.
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. [QxMD MEDLINE Link].
Eisenberg E, Barmeir E, Bergman R. Notalgia paresthetica associated with nerve root impingement. J Am Acad Dermatol. 1997 Dec. 37(6):998-1000. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Savk E, Savk SO. On brachioradial pruritus and notalgia paresthetica. J Am Acad Dermatol. 2004 May. 50 (5):800-1. [QxMD MEDLINE Link].
Weber PJ, Poulos EG. Notalgia paresthetica. Case reports and histologic appraisal. J Am Acad Dermatol. 1988 Jan. 18(1 Pt 1):25-30. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Savk O, Savk E. Investigation of spinal pathology in notalgia paresthetica. J Am Acad Dermatol. 2005 Jun. 52(6):1085-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
Tait CP, Grigg E, Quirk CJ. Brachioradial pruritus and cervical spine manipulation. Australas J Dermatol. 1998 Aug. 39(3):168-70. [QxMD MEDLINE Link].
Low R, Swanson LA, Swanson DL. Notalgia Paresthetica Relieved by Cervical Traction. J Am Board Fam Med. 2017 Nov-Dec. 30 (6):835-837. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Yosipovitch G, Samuel LS. Neuropathic and psychogenic itch. Dermatol Ther. 2008 Jan-Feb. 21(1):32-41. [QxMD MEDLINE Link].
Stellon A. Neurogenic pruritus: an unrecognised problem? A retrospective case series of treatment by acupuncture. Acupunct Med. 2002 Dec. 20(4):186-90. [QxMD MEDLINE Link].
Weinfeld PK. Successful treatment of notalgia paresthetica with botulinum toxin type A. Arch Dermatol. 2007 Aug. 143(8):980-2. [QxMD MEDLINE Link].
Goodless DR, Eaglstein WH. Brachioradial pruritus: treatment with topical capsaicin. J Am Acad Dermatol. 1993 Nov. 29 (5 Pt 1):783-4. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Pereira J. Brachioradial pruritus treated with thalidomide. An Bras Dermatol. 2005. 80:295-6.
Alai NN. What Caused This Refractory Pruritic Eruption?. The Dermatologist. Available at https://www.the-dermatologist.com/article/what-caused-refractory-pruritic-eruption. September 2016; Accessed: February 20, 2020.

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.

of 5

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.