INTERDISCIPLINARY ASPECTS OF NOTALGIA PAR AESTHETICA

For 3 years a 75-year-old man with type II diabetes had been suffering from paroxysmal pruritus in a circumscribed area of brown discolorati on of the skin over the left shoulder blade. This condition, also know n as notalgia paraesthetica, is a rare, but perhaps underdiagnosed, ne urocutaneous entity, a largely sensory neuropathy due to a muscular co mpression phenomenon. In this case histological examination of a biops y specimen showed focal akanthosis, obvious basal hyperpigmentation an d discrete perivascular lymphocytic infiltration with numerous melanop hages. At first, glucocorticoids were administered unsuccessfully agai nst the distressing pruritus. Purely symptomatic local capsaicin treat ment decreased the pruritus temporarily. Endocrinological diagnosis fa iled to demonstrate multiple endocrine neoplasia (MEN) syndrome 2A, wh ich has been frequently described in association with notalgia paraest hetica.