Notalgia paraesthetica Astwazaturow and Connective Tissue Massage
Notalgia paraesthetica continues to thwart our efforts to treat it effectively. It was described in 1934 by Astwazaturow and is an intensely pruritic patch between the shoulder blades (C7-Th6). It most often affects women above 50 years of age.
It seems to be due to irritation and damage of the rami posteriores. One can usually confirm some pathology of the spine or intervertebral discs at the level of the Notalgia paraesthetica. Subsequent to the patient’s effort to scratch, a localized (often rectangular) hyperpigmentation arises at the spot. We often say it is a cutaneous amyloidosis – however, only in about 12% of cases does one actually confirm amyloid deposits in a biopsy.
Our treatments so far were capsaicin cream in increasing dosages, local anaesthetics, menthol (a great favourite of mine in not too low concentrations) and sometimes gabapentin.
In treatment resistant cases (many), colleagues have even put forward a plan to excise the lesion fully… that may be somewhat extreme, though. We are thinking about utilizing connective tissue massage on grounds that eliciting neural reflexes might be able to contribute to improval of the problem. You’re welcome to let us know your opinion on this strategy.
Reference: Huesmann et al. Acta Derm Ven 2012 Goats et al. Brit J Sports Med 1991