Notalgia paresthetica: the unreachable itch

BACKGROUND Notalgia paresthetica (NP) is a very common, under-recognized condition characterized by pruritus in a unilateral, dermatomal distribution in the mid-back. Chronic pruritus is sometimes accompanied by pain, paresthesias, or altered sensation to touch. OBJECTIVES To review the current literature with regards to the cause of NP and its most appropriate treatment. METHODS Comprehensive literature review using PubMed to inspect the available data on NP. RESULTS The most likely cause of NP is cutaneous nerve damage. Many therapies have been tried in the treatment of NP, mostly in small case studies. CONCLUSIONS The published cases and studies suggest symptoms of NP are due to a cutaneous sensory neuropathy. Treatments addressing the condition as such are more successful than traditional itch therapies. In many cases, a simple explanation for the persistent pruritus is satisfactory for patients. For very distressing cases, therapy should address the condition as a benign sensory neuropathy. Further studies are needed to evaluate which treatments have the greatest potential for providing symptom relief.