Notalgia Paresthetica Following an Osteoporotic Compression Fracture

A 74-year-old female patient had a 2-year history of severe itch in the right gluteal region. Treatment with cortisone cream proved unsuccessful. Only intense scratching relieved the pruritus. The L5 dermatome showed brownish hyperpigmentation extending from the cranial aspect of the intergluteal cleft to the right in a lateral-caudal direction (Figure). Skin biopsy revealed irritation-related acanthosis and postinflammatory hyperpigmentation. Prior to symptom onset, the patient had broken a number of lumbar vertebrae (osteoporotic compression fracture). Magnetic resonance imaging also showed disc protrusion that was in contact with the L5 nerve root. The fractured vertebrae were treated by means of transpedicular kyphoplasty. Postoperatively, there was no neurological deficit. We diagnosed notalgia paresthetica. This rare sensory neuropathy is associated with spinal nerve compression or degenerative vertebral lesions in the region of the corresponding dermatome as well as with peripheral nerve disorders. Its site of predilection is the unilateral (inter-) scapular region. In the predominantly female patients of middle age, the neuropathic pruritus induces chronic scratching and rubbing, which thickens the stratum corneum (acanthosis) and triggers hyperpigmentation. Treatment options primarily include capsaicin cream, local anesthetics, systemic gabapentinoids, or surgical decompression. Our patient benefited from topical capsaicin.

Figure

a) Streaky, brownish hyperpigmentation in the region of the right L5 dermatome; b) disc protrusions in contact with the right L5 nerve root on MRI (sagittal LS, T2W)

Acknowledgments: The authors would like to thank Lena Müller for the clinical photo and the Alter Markt group radiology practice in Wuppertal, Germany, for performing the MRI.

David Gaycken, Prof. Dr. med. Silke Hofmann, Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, [e-mail]

PD Dr. med. Axel Pommer, Klinik für Wirbelsäulenchirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Gaycken D, Pommer A, Hofmann S: Notalgia paresthetica following an osteoporotic compression fracture. Dtsch Arztebl Int 2025; 122: 340. DOI: 10.3238/arztebl.m2025.0017