Notalgia paresthetica: a review for dermatologists
MBBS (Hons), BPharm (Hons)
, Lukas Sahhar
MBBS (Hons), BMedSci
, Frank Andrews
B App Sci (Physio), M Musc Physio
, Ralph Bergman
B App Sci
, and Douglas Gin
Department of Medicine, St Vincent’s
Hospital, Melbourne, Victoria, Australia,
Royal Victorian Eye and Ear Hospital,
Melbourne, Victoria, Australia,
Physiotherapist. Berwick Physio, Berwick,
Physio, Mulgrave, Victoria, Australia, and
Department of Dermatology, Alfred
Hospital, Melbourne, Victoria, Australia
Department of Medicine
St Vincent’s Hospital, Melbourne
2/148 Wells Street, South Melbourne
Funding sources: This article has no
Conﬂict of interests: The authors have no
conﬂicts of interest to declare
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.
Notalgia paresthetica (NP) was named and ﬁrst described in
1934 by the researcher Astwazaturow using Greek nomencla-
ture: notos and algos, translating to back and pain.
was universally denoted as a distinct clinical entity, multiple
descriptors were used for this condition such as lichen amyloi-
dosis, cutaneous dorsal amyloidosis, and localized shoulder
pruritus until Weber in 1988 consolidated the neurological and
dermatological observations into the same diagnosis.
Classically, NP occurs in the midscapular region affecting der-
matomes T2-6 with pruritus. There may be associated pain,
paresthesia, hypoesthesia, or hyperesthesia. In some patients,
a hyperpigmented macule or licheniﬁcation is present in this
region secondary to chronic rubbing/scratching with postinﬂam-
matory pigmentary change as the proposed mechanism.
Complicating the ability to conﬁdently make a clinical-based
diagnosis is that the typical hyperpigmented patch was not seen
in up to two-thirds of patients in a recent cross-sectional study.
As noted by many clinicians, this hyperpigmented region can
also resemble macular amyloidosis, Figures 1 & 2.
The prevalence of reported cases of NP is higher in women;
in mid to late adulthood, however, there is no clear racial
Mean age of onset in one large case series was
The condition typically lasts at least multiple
years, with a mean duration reported by Weber and Wallengren
between 21 months and 3 years.
Although only a small num-
ber of reports are published, it is believed that NP is relatively
common but perhaps underdiagnosed.
Female gender may
predispose to a worse severity of symptoms and increased BMI
to a longer course of NP.
The etiology of NP is currently unclear, however, the leading
proposition is that it is a sensory neuropathy. Intervertebral disk
disease or vertebral degenerative changes may impinge
International Journal of Dermatology 2018, 57, 388–392 ª 2017 The International Society of Dermatology