Chronic Itchy Back: What Should You Know?

Notalgia paresthetica (NP) is a chronic itchy back syndrome that is underdiagnosed and poorly understood by many clinicians due to a lack of research of this condition.

A recent review sought to update clinicians with information on the pathogenesis, clinical features, biopsy features, risk factors, and management options. NP can be tricky to diagnose because patients may or may not present with an itchy back and an accompanying hyperpigmented patch on their back. The authors state that NP is more common in women.

The pathogenesis is unknown, but the studies in the review pointed to sensory neuropathy as a possible cause, perhaps due to causes of spinal trauma such as disk herniation, spinal canal stenosis, scoliosis, motor vehicle/motorbike accidents, and occupational- related degeneration.

There are many possible treatments ranging from capsaicin cream to botox, nerve blocks and pharmaceutical options such as gabapentin or amitriptyline. Other effective treatments were encouraging exercise and stretching exercises.

The review showed a lot of variance in effectiveness in treatment modalities, especially for long-term relief. The authors conclude that due to the many postulated causes/associations with NP that this ‘syndrome’ cannot be treated with a single modality. They suggest a multimodal approach that includes both pharmacological and nonpharmacological management.