This article has been peer reviewed and approved by Michael Fisher, MD, Professor of Medicine, Albert Einstein College of Medicine. Review date: January 2010.
Drs. Alai, Skinner, Nabili, Jeffes, Shahrokni, and Saemi report no conflict of interest. The authors discuss off-label use of botulinum toxin injections, carbamazepine, doxepin hydrochloride, gabapentin, oxcarbazepine, and thalidomide. Dr. Fisher reports no conflict of interest. The staff of CCME of Albert Einstein College of Medicine and Cutis® have no conflicts of interest with commercial interest related directly or indirectly to this educational activity. Dr. Alai is Assistant Clinical Professor, Department of Dermatology and Department of Family Medicine; Dr. Skinner is Professor Emeritus, Department of Orthopaedic Surgery; Dr. Nabili is Assistant Clinical Professor, Department of Internal Medicine; Dr. Jeffes is Professor, Department of Dermatology; all at University of California, Irvine. Dr. Shahrokni is Associate Professor, University of California, San Diego. Dr. Saemi is a resident, Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
Nili N. Alai, MD; Harry B. Skinner, MD, PhD; Siamak T. Nabili, MD, MPH; Edward Jeffes, MD, PhD; Seyed Shahrokni, MD; Arash M. Saemi, MD
Notalgia paresthetica (NP) is a common refractory, sensory, neuropathic syndrome with the hallmark symptom of localized pruritus of the unilateral infrascapular back. It generally is a chronic noncurable condition with periodic remissions and exacerbations. While the dermatologic syndrome may be multifactorial in etiology, a possible association with underlying cervical spine disease should be evaluated for proper treatment. Collaborative multispecialty evaluation by dermatology, radiology, orthopedic surgery, and neurology may be indicated for primary management of this condition. First-line therapy for NP with associated cervical disease may include nondermatologic noninvasive treatments such as spinal manipulation, physical therapy, massage, cervical traction, cervical muscle strengthening, and oral nonsteroidal anti-inflammatory drugs and muscle relaxants. Notalgia paresthetica may in fact be a cutaneous sign of an underlying degenerative cervical spine disease. We report a case of a patient with cervical spinal stenosis that corresponded directly with the clinical findings of NP.
