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.