Itch & Neuropathic
Notalgia Paresthetica
WHAT IS IT
A nerve-related itch on the upper back
HOW COMMON
Common, often in middle-aged adults
CONTAGIOUS?
No — you cannot catch it or spread it
CURABLE?
Manageable; symptoms can be controlled
What Is It?
Notalgia paresthetica is a chronic, itchy (sometimes burning or tingling) patch on the upper back, usually just below one shoulder blade. Over time, repeated scratching can leave a darker, thickened patch of skin. It is a nerve-related (neuropathic) itch, not a primary skin disease.
Signs & Symptoms
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Itching, burning, or tingling on the upper/mid-back
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Usually a single patch, often below a shoulder blade
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A darker, thickened patch from chronic scratching
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Little or no primary rash to explain the itch
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Symptoms that flare and settle over time
Why Does It Happen?
The itch is thought to come from irritation of nerves that exit the spine in the mid-back, often related to wear-and-tear changes or muscle tension in the spine. This causes an itch signal even though the skin itself is healthy. It is NOT an infection and NOT contagious.
Treatment Options
Treatment calms the overactive nerve signals and protects the skin from scratching. Consistency matters, and relief may build over several weeks.
TOPICAL CAPSAICIN
Reduces nerve itch signals with regular use over weeks.
TOPICAL ANESTHETICS
Lidocaine or similar for short-term itch relief.
NERVE-CALMING MEDICINES
Gabapentinoids for stubborn or severe neuropathic itch.
SPINE & POSTURE CARE
Physical therapy and posture work if the spine contributes.
Tips for Managing It at Home
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Avoid scratching — it worsens itch and darkens the skin
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Apply prescribed creams consistently to see benefit
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Try a cool compress for quick, temporary relief
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Work on back and neck posture and stretching
When to Call Your Provider
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The itch disrupts sleep or daily activities
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The skin breaks down, bleeds, or looks infected
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New back pain, numbness, or weakness develops
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Symptoms don't improve after a fair treatment trial
Sources & further reading
The information in this handout is based on general dermatology guidance from the reputable organizations below. These links are provided for patients who wish to read more from trusted sources.
DermNet. Notalgia Paraesthetica. https://dermnetnz.org/topics/notalgia-paraesthetica
DermNet. Neuropathic Itch. https://dermnetnz.org/topics/neuropathic-itch
MSD/Merck Manual. Pruritus. https://www.msdmanuals.com/professional/dermatologic-disorders/approach-to-the-dermatologic-patient/pruritus
This handout is for general education and does not replace advice from your own provider. Always follow your provider’s specific instructions.
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