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Notalgia paresthetica is a neurocutaneous disorder characterised by abnormal sensations in a well-defined area of the back. The sensations consist in paresthesia, ranging from pruritus or tingling to real pain. No abnormalities are detected on physical examination of the skin. The signs are similar for meralgia paresthetica, lumbago and brachialgia paresthetica.
Notalgia paresthetica is therefore a sensory neuropathy. The innervation of the skin is increased. It has been suggested that the condition may be related to compression of the nerve roots of the spinal column. Notalgia paresthetica is sometimes associated with Sipple’s syndrome (multiple endocrine neoplasia) and may therefore have a familial origin.
There is much debate about the relationship between notalgia paresthetica and macular amyloidosis. Cutaneous amyloidosis is characterised by limited pruriginous pigmented plaques. For some, the two diseases may sometimes occur together while for others, notalgia paresthetica is one of the aetiologies of amyloidosis.
TOOLS AND TREATMENT STRATEGY
Notalgia paresthetica is primarily treated by topical capsaicin. Capsaicin inhibits the release of neuropeptides by dermal nerve fibres by binding to the TRPV1 receptor. Capsaicin is not currently commercialised in France, but it is in several other countries. However, it is available as a compounded mixture (capsicum tincture 12.5 g and vaseline 37.5 g; refrigeration required) and must be applied twice daily for two months. The patient must be warned that a slight burning sensation is common at the start of treatment. Treatment must be reapplied if the symptoms recur. Other local anaesthetic treatments may also be used (Emla® cream). Patients may also be treated orally with tricyclic antidepressants such as amitriptyline (at least 50 mg/d). Antihistamines have no particular effect. The most effective treatments appear to be gabapentin and pregabalin. Patients may also be treated by physiotherapy (ultrasound). Paravertebral nerve block or transcutaneous electrical nerve stimulation may be attempted as last resort treatments.
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