๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Notalgia paresthetica
Notalgia paresthetica
Clinical features Notalgia paresthetica is a common sensory neuropathy characterized by pruritus on the back involving an area innervated by the dorsal spinal nerves 2โ6.1โ5 In one case, the condition was attributed to cervical spinal stenosis and in a further case it was associated with neuralgic amyotrophy.6,7 Additional symptoms include burning and dysesthesia. A study has found that females tend to present more severe symptoms, patients with higher body mass index have longer disease duration, and the affected site is associated with the prevailing sleep position.8 Interestingly, lesions in women tend to be more common in the subscapular area and in men in the interscapular area. This may be due to the differences between the length of the arm in males and females.9 Notalgia paresthetica mainly occurs in elderly patients and presents with well-defined areas of macular hyperpigmentation. The disease probably represents the same entity that has been described as macular posterior pigmentary incontinence.9โ11 The lesions are also similar to macular amyloidosis, and amyloid is often found in biopsies taken from involved sites (see below).10 Symptoms tend to be persistent and treatment is difficult.12 An association with multiple endocrine neoplasia syndrome 2A has been reported.13 A case of inverse notalgia paresthetica with involvement of the parasternal area, probably associated with the patientโs trade as a painter, has been documented.14
clinicopathological correlation is therefore essential to establish the correct diagnosis, as macular amyloid does not follow the distribution of the innervation of dorsal nerves.