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Oh, Your Itching Back – Coping with Notalgia Paraesthetica

Posted on: February 5th, 2020 by Kristen Chang

Got an itch that won’t quit? Is it below your shoulder blades and you can’t quite reach it? Do you own a long-handled back scratcher or two?  Has repeated scratching created brown patches on the itchy areas?

If you answered yes to two or more of the above questions, you may have notalgia paraesthetica, an irritating but benign condition.

You are not alone. About 15% of Americans — 50 million people — suffer from a chronic itch, half of which is believed to be due to notalgia paraesthetica.


Itching, medically called pruritus, can occur in many parts of the body from a variety of causes. Some of the most common include insect bites, dry skin, wound healing, eczema, psoriasis and allergies to certain foods, fabrics, fragrances or other environmental factors. Sometimes itching can be a symptom of a more serious illness such as liver disease, thyroid conditions and certain types of cancers. Itching can also be a response to stress.

But with notalgia paraesthetica, the skin of the upper back becomes intensely itchy. Repeated scratching of the itch is difficult to resist. This overstimulates the pigment cells of the affected areas causing brownish patches of hyperpigmentation.

What Causes Notalgia Paraesthetica?

Notalgia paraesthetica can affect people of any age, race, or gender. However, women seem to develop notalgia paraesthetica more frequently than men.

Because it is not fully understood, it is not certain what causes it or whether the same cause is true for everyone with the condition. It may be caused by a glitch in the nerve cells that transmit feeling to the skin of the upper back (sensory neuropathy).  It may be hereditary. Some medical researchers suggest that it is the result of an underlying compression problem in the vertebrae. In some instances, women may develop it as a result of immune system changes in pregnancy.

The good news is that notalgia paraesthetica is not a progressive illness. It will not get worse. But on the other hand, it won’t get better either.

At-Home Treatment of Notalgia Paraesthetica

Notalgia paraesthetica has no known cure at present. The best approach is to manage the symptoms through one or more types of treatment. It may take trying different treatment approaches to find one that works best for you. It is important to allow each treatment enough time to determine whether it is effective.

Your best ally in treating the itch is your California Skin Institute board-certified dermatologist. Although many first line treatment products are over-the-counter and do not require a prescription, your California Skin Institute dermatologist can steer you to ones that are free of fragrances and other ingredients that could aggravate your skin condition.

Try these self-care methods for temporary relief:

  1. Moisturize daily.
  2. Use creams, lotions or gels that soothe and cool the skin.
  3. Avoid scratching as much as possible.
  4. Reduce stress.
  5. Try over-the-counter allergy medicine.

Advanced Treatment Options

If the above treatments do not provide relief, others can be explored with your California Skin Institute dermatologist. Capsaicin, a medication derived from an active ingredient in pepper plants and the most successful topical medication reported, can be applied as a cream, gel, lotion, solution or patch in a wide variety of concentrations. Gabapentin, a medication developed to treat epilepsy, has also been found to be effective in treating neuropathic conditions.

Some researchers have reported success in treating notalgia paraesthetica with Botulinum Toxin A, also known as Botox. Other researchers claim favorable results for transcutaneous electrical nerve stimulation (TENS) therapy — low-voltage electric currents generally used to treat pain. These treatment modalities for notalgia paraesthetica are in the experimental stages and await the outcome of additional studies.

If you think you have notalgia paraesthetica, make an appointment with your California Skin Institute board-certified dermatologist to rule out other possible conditions and map out treatment options as soon as possible.