Medical Dermatology

Notalgia Paresthetica

Notalgia Paresthetica (NP) is characterized by itching, burning, pain, tenderness, or increased sensitivity on the skin of the back. There may also be decreased touch and temperature sensation. The most common location for NP is the upper back between the shoulder blades. Symptoms may be confined to one or both sides of the upper back or solely in the middle.

Though it is not known with certainty what causes NP, some studies suggest that pressure on a nerve due to age or injury may cause the symptoms. Others believe there may be a hereditary connection.

Notalgia paresthetica affects people of any age, race, or sex. However, it is more common in middle-aged to older adults. Women tend to develop NP more frequently than men.

Dry skin is a common cause of itching, so twice daily moisturizes should be used.

If moisturizers are not helpful, an over-the-counter cream containing capsaicin (an extract of hot peppers) may be effective. Capsaicin cream does not provide immediate relief and may take up to six weeks for maximum effect. Even if capsaicin cream is effective, symptoms may return when it is discontinued.

Strong cortisone creams (prescription-strength) and/or topical anesthetics are often quite effective.

Dupuytren's Contracture

Dupuytren’s Contracture is a deformity of the palms whereby the fingers become irreversibly flexed, thereby limiting useful function of the hand(s).  The connective tissue around the tendons, which course through the palms and fingers allowing one to bend the fingers, becomes thickened and hard to the touch.  This causes a contraction or pulling the affected finger(s) into a bent position resulting in an inability to lay the hand flat against a surface. The middle, ring and little fingers are most commonly affected; however, it can affect any one of them or even the thumb.  A similar condition can occur on the feet and presents as a thickened area or lump usually in the arch of the foot.

The cause is unknown.  The middle-aged and elderly are most commonly affected.  People who smoke or drink alcohol excessively, or who have diabetes are at an increased risk for Dupuytren’s Contracture.

Early treatment is very effective and can prevent deformity and loss of function.  Dr. Parnell has been treating Dupuytren’s contracture with intralesional steroids since the mid-1980’s with invariable success.  We do not know of a single patient among many hundreds treated who have progressed and required surgery.  The thickened, hard knots around the tendons soften with treatment.  Disease progression can be halted even when contractures have occurred.

Once contractures have occurred, they may be treated with collagenase and surgical release. This costs in the vicinity of $5,000 per hand and is not always satisfactory. Therefore, it is best to opt for early treatment.

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