What are the other Names for this Condition? (Also known as/Synonyms)

• Back Scratcher’s Itch
• Posterior Pigmented Pruritic Patch
• Subscapular Pruritus

What is Notalgia Paresthetica? (Definition/Background Information)

• Notalgia Paresthetica is a common, itchy, skin condition. The itching is present on one half of the body (unilateral), especially between the shoulder blades. Hence, the condition is also called Interscapular Itch or Back Scratcher’s Itch
• The cause of Notalgia Paresthetica is unknown in a majority of cases. However, the condition is associated with abnormalities or injuries to the neck and spine
• The signs and symptoms of Notalgia Paresthetica include itching, skin rashes, shoulder pain, and emotional trauma. The complications of the condition are not significant
• The prognosis of Notalgia Paresthetica with appropriate treatment is generally good, though it is dependent upon many other factors, such as severity of the condition and treatment response

Who gets Notalgia ParestheticaNotalgia Paresthetica? (Age and Sex Distribution)

• Notalgia Paresthetica can occur at any age, but is more common between the ages of 35-55 years
• Both males and females can be affected; though the condition is more common in middle-aged women
• It can occur worldwide in any race or ethnic group

What are the Risk Factors for Notalgia Paresthetica? (Predisposing Factors)

The risk factors for Notalgia Paresthetica include the following:

• Muscle spasms of the back
• Cervical degenerative osteoarthritis
• Trauma to the neck region
• Motor vehicle (or sports-related) accident with whiplash type injury
• Excessive weightlifting

Certain occupations are known to increase the risk and these include:

• Hairdresser
• Paining
• Tanning leather worker

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Notalgia Paresthetica? (Etiology)

The cause of Notalgia Paresthetica is unknown in a majority of cases. Some researchers believe that it is a type of neuropathic itch caused by the entrapment of spinal sensory nerves as they pass through the areas of muscle and fascia, near the entry to the spinal cord.

• Notalgia Paresthetica is not contagious; it cannot spread from one individual to another through close interactions
• There is no definitive proof that certain types of diet plays an important role in the development of Notalgia Paresthetica

What are the Signs and Symptoms of Notalgia Paresthetica?

The signs and symptoms due to Notalgia Paresthetica have variable severity. In some cases, it causes mild signs and symptoms, while in others the signs and symptoms may be very severe.  It is difficult to predict who will get mild or severe signs and symptoms.

Individuals with Notalgia Paresthetica can have the underlying skin signs and symptoms such as

• Itching, pain, and tenderness in the affected area; the itching is typically felt on the upper to mid back region, between the shoulders
• Skin rashes, scaly skin, dry skin patches
• In some, pins and needles type of sensation may be felt; some may have burning sensation
• Chronic itching and scratching leads to hyperpigmentation of the affected area (darkening of skin lesions)
• Altered sense of touch in the affected area

Individuals with Notalgia Paresthetica may have the underlying musculoskeletal signs and symptoms such as:

• Kyphoscoliosis or lumbar lordosis - abnormal curvature of the back bone
• Shoulder pain
• Muscle pain (myalgia)

Individuals with Notalgia Paresthetica can have the underlying behavioral signs and symptoms such as:

• Depressed mood
• Emotional stress or trauma

The signs and symptoms may last for months and years and there may be recurring episodes or relapses. The timing and development of the signs and symptoms are important factors for the correct diagnosis of the condition.

How is Notalgia Paresthetica Diagnosed?

The following are the diagnostic methods used for Notalgia Paresthetica:

• A thorough physical examination and a complete medical history are very crucial. The diagnosis may be arrived at clinically by analyzing the signs and symptoms
• A complete evaluation of one’s medical history to learn about the causative agent which could be the source of the condition
• Radiological studies such as:
  • X-ray
  • CT scan of the head and neck         
  • MRI scan of spine
• Laboratory testing may include electromyogram (EMG)
• A skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. The skin biopsy is performed to eliminate other causes of itching such as tinea versicolor, contact dermatitis, macular amyloidosis, and parapsoriasis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Notalgia Paresthetica?

No significant complications due to Notalgia Paresthetica have been reported.

• Chronic itching and scaling of the skin can cause the skin to become thick, discolored, and leathery. Excessive scratching can lead to skin ulceration
• Increased psychological stress can occur due to Notalgia Paresthetica, which may affect one’s performance at school and work

Parents and teachers should be alert and provide appropriate support to decrease the emotional stress.

How is Notalgia Paresthetica Treated?

In majority of the cases, steroids and antihistamine creams are not helpful. The following treatment measures have been found to be helpful for Notalgia Paresthetica in some individuals, but not in others:

• Topical capsaicin
• Botulism toxin A injection
• Local nerve block
• Surgery to decompress trapped nerves
• Transcutaneous electrical nerve stimulation
• Acupuncture therapy
• Massage therapy
• Upper body muscle strengthening exercises

Other treatment measures may include:

• The individual needs reassurance that the condition is harmless and has excellent outcome. Educating the individual and assuring the benign nature of the condition will help decrease anxiety and stress
• Surgery: Severe conditions may need surgical intervention 
• Notalgia Paresthetica can recur after treatment; hence, close monitoring through periodic follow up checks ups is necessary

A few self-care tips and home remedies for the condition may include:

• Scratching the affected areas must be completely avoided
• Wearing smooth cotton clothes will help

How can Notalgia Paresthetica be Prevented?

Currently, there are no specific methods or guidelines to prevent Notalgia Paresthetica, which is caused due to genetic factors. However, some of the risk factors may be controllable, such as:

• Avoiding excess weightlifting
• Taking adequate safety and health precautions while performing certain occupations
• Prevent whiplash injuries through the use of proper sports safety gear, wearing seat belts

What is the Prognosis of Notalgia Paresthetica? (Outcomes/Resolutions)

• The prognosis of Notalgia Paresthetica is excellent with appropriate treatment. But it also depends on the severity of the signs and symptoms. Also, the condition can affect the quality of life and be stressful (causing depression and reduced self-esteem) to the affected individual
• Family members should be alert for this possibility and early professional intervention will help. Regular follow up visits with healthcare providers are important
• Individuals with milder signs and symptoms have a better prognosis than those with severe presentations. The signs and symptoms can recur in up to 40% of the cases, hence careful follow-up is necessary

Additional and Relevant Useful Information for Notalgia Paresthetica:

A differential diagnosis may be considered to eliminate the following conditions:

• Tinea versicolor
• Contact dermatitis
• Macular amyloidosis
• Parapsoriasis