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Notalgia paresthetica: An unknown condition by doctors
1 Undergraduate in Medicine at the Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
2 Neurologist, Professor of Neurology at the Iguaçu University (UNIG), Nova Iguaçu, RJ, Brazil
3 Neurologist, Professor of Medicine at Universidade Iguaçu, Universidade Iguaçu – UNIG/RJ, Nova Iguaçu, Brazil
Address correspondence to:
Antônio Marcos da Silva Catharino
Rua Gavião Peixoto 70, Room 811, Icaraí – Niterói, Rio de Janeiro, CEP 24.2230-100,
Brazil
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Article ID: 101218Z01DP2021
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How to cite this article
Prata DC, Orsini M, Martins Jr GC, da Silva Catharino AM. Notalgia paresthetica: An unknown condition by doctors. Int J Case Rep Images 2021;12:101218Z01DP2021.ABSTRACT
No Abstract
Keywords: Hyperpigmentation, Neuropathic pain, Pruritus, Skin disease
Case Report
JRO, a 68-year-old male, with a clinical history of diabetes, complaining of pruritus in the right dorsal topography. The physical examination revealed a pigmented lesion in the affected region, suggestive of notalgia paresthetica (NP) (Figure 1). Treatment with pregabalin 75 mg/day was initiated with good clinical response.
Discussion
Notalgia paresthetica (NP) is a little-known condition, with characteristic symptoms that can be described by the patient and observed on physical examination. The most common complaints are the presence of pruritus in the dorsal region, hyperpigmentation, hypopigmentation centrally located in the affected region and referred pain with the characteristics of neuropathic pain [1],[2]. It usually affects the dorsal region, being located between the vertebrae T2 and T6 [1],[2],[3],[4]. In diagnostic investigation, imaging tests such as radiography and magnetic resonance imaging of the dorsal spine, and electromyography can be performed, aiming to identify vertebral degenerations that affect nerve roots [3]. The condition is more common in adults and when it occurs in young patients it may be related to multiple endocrine neoplasia type 2A [4].
Diagnostic and therapeutic alternatives have been investigated by several specialists, a study developed by Mülkoglu et al. (2020) [1], reported the intradermal application of lidocaine in patients with NP, thus with varied results, but some with positive responses, resulting in partial or total resolution of the pruritus, another promising therapeutic proposal is the application of intradermal botulinum toxin type A (BTX-A), described by Pérez-Pérez et al. (2013) [2]. BTX-A inhibits the release of substance P resulting in a significant improvement in the itching induced by the release of histamine in the affected region.
Conclusion
Notalgia paresthetica is a poorly recognized condition in terms of its diagnosis and treatment, although there are still a few reported cases, we observed a symptomatic and etiological similarity among patients. The clinical evolution to a sensory neuropathy is the main target of studies described in the literature, since, in many cases this condition generates enormous discomfort to the patient, thus leading to a worsening in the quality of life.
Thus, we concluded that the treatments currently proposed relief of symptoms and, in some cases, obtain the cure, providing a life of quality and comfort to patients with NP. In the presented case, the authors obtained a good result with the use of pregabalin.
REFERENCES
1.
Mülkoğlu C, Nacır B. Notalgia paresthetica: Clinical features, radiological evaluation, and a novel therapeutic option. BMC Neurol 2020;16;20(1):191. [CrossRef]
[Pubmed]
2.
Pérez-Pérez L, García-Gavín J, Allegue F, Caeiro JL, Fabeiro JM, Zulaica A. Notalgia paresthetica: Treatment using intradermal botulinum toxin A. Actas Dermosifiliogr 2014;105(1):74–7. [CrossRef]
[Pubmed]
3.
Terzi R, Bekdik Şirinocak P. A rare cause of neuropathic pain in the back: Notalgia paresthetica. Noro Psikiyatr Ars 2016;53(1):89–90. [CrossRef]
[Pubmed]
4.
Šitum M, Kolić M, Franceschi N, Pećina M. Notalgia paresthetica. Acta Clin Croat 2018;57(4):721–5. [CrossRef]
[Pubmed]
SUPPORTING INFORMATION
Author Contributions
Diego Carvalho Prata - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Marco Orsini - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Gilberto Canedo Martins Jr - Conception of the work, Design of the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Antônio Marcos da Silva Catharino - Acquisition of data, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Diego Carvalho Prata et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
