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Notalgia Paresthetica

Notalgia paresthetica is a chronic neuropathic dysesthesia of unknown etiology characterized by a pruritus located on the medial border of the inferior scapula. First described in 1934 by a Russian neurologist, notalgia paresthetica has had few studies due to its benign nature. Irritation or damage to thoracic nerves two to six have been implicated as causative, but the exact location of damage has not been elucidated. Most studies attribute a thoracic polyradiculopathy due to spinal nerve compression as the primary etiology behind the pruritus. Others state the anatomical angle of sensory nerve fiber penetration through the surrounding muscle is the cause. Notalgia paresthetica is typically seen in older females, is unilateral, and can last for months to years. There are no primary cutaneous lesions, only secondary changes due to chronic scratching. Diagnosis through a history and physical is typically sufficient, but occasionally further imaging may be required. Treatment remains disappointing and oral neurologic modulators, such as gabapentin, are reported to be the most efficacious therapy.

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