Complaints & connections · borters.ch
Notalgia paraesthetica
Always the same itching spot under one shoulder blade, over time a brownish patch — the itch comes from the nerve, not from the skin.
Also known as: notalgia · neuropathic back itch · subscapular itch
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
A stubborn itch at one place on the upper back, usually inside and below one shoulder blade, often on one side only and always in exactly the same place — that is the whole picture. The skin looks normal at first; after months to years the rubbing creates a brownish, slightly thickened patch that looks like a pigment mark and is then taken for one. Often burning, tingling, a feeling of cold or a place that is oversensitive to touch come with it. The cause does not lie in the skin but in the nerve: the small skin nerves from the middle of the thoracic spine are irritated or squeezed on their way through the back muscles — by wear at the vertebrae, a posture, a rucksack or tense muscles. That is why no moisturiser and no antihistamine helps there, and why the spot stays so unchangingly the same. It is harmless and not catching, but it can be very stubborn and last for years. What helps works either on the skin — cooling or numbing preparations, capsaicin — or on the nerve and the spine: physiotherapy, strengthening of the upper back, and in marked cases drugs meant for nerve pain.
A cool damp cloth or a cold pack for a few minutes interrupts the stimulus without thickening the skin. Every rub deepens the brownish patch.
The pungent substance of chilli empties the nerve endings of their messenger. The first days burn markedly, after that the itching eases for many. Not on broken skin, wash hands afterwards, and not near the eye.
Physiotherapy with exercises for the muscles between the shoulder blades and for the thoracic spine is the route that works at the cause. It acts slowly and needs weeks.
One-sided straps, a rucksack that is too heavy, a chair without back support, long sitting with a rounded back. These are the quiet, constant irritations that keep the nerve from settling.
The same substances used for nerve pain also damp nerve itching. They make one tired at the start and are increased slowly — that belongs in the planning.
So that the classification is right: a brownish patch on the back can also be ringworm, a pigment disorder or something in its own right. Once settled it does not need checking again.
Cortisone ointment does little here, because the skin is not inflamed — the itch comes from an irritated nerve passing between the back muscles. What has been studied: capsaicin cream, which desensitises the nerve endings over two to four weeks and burns at first, and local anaesthetic patches. Gabapentin or amitriptyline act on nerve excitability. What eases the nerve is physiotherapy for the mid-back.
The itch typically sits below the shoulder blade, usually on the right, in an area the size of a palm — and over the years a brownish mark appears there, because the spot is rubbed again and again. Mainly people over forty are affected. Capsaicin cream is applied four times a day over two to four weeks and burns in the first days; after stopping, the itch returns within weeks. In about half, a change in the mid-back spine is found.
Inside and below one shoulder blade, palm-sized or smaller, usually one-sided, unchanged in the same place for months or years. This constancy is the strongest pointer.
It only arises over time, is blurred at the edges and slightly thickened. It is the consequence, not the cause — and it is very often taken for a pigment mark or a fungus.
Burning, tingling, a feeling of cold, a stabbing or an oversensitivity to touch in the same place. This mixture points to the nerve and away from the skin.
If moisturisers, cortisone and tablets against itching achieve nothing over weeks, that speaks against a skin cause — and is itself already a pointer.
Wear at the middle of the thoracic spine, tension between the shoulder blades, a heavy rucksack, long sitting with a rounded back. In many the itch can be strengthened by pressing on a point beside the spine.
A patch that grows, changes colour, is irregularly bordered or bleeds; itching all over the body; fever, night sweats or weight loss. That belongs investigated in its own right.
A lack causes sensations of its own in the skin and lowers the threshold for nerve itching. It belongs with any itching without a rash.
An empty store lowers the itch threshold in general and so makes this spot more unpleasant than it need be.
Belongs to the basic workup of a lasting itch, even though it does not explain this spot. A value that rules out many other possibilities at once.
Also part of the basic workup with itching and no rash. With a complaint strictly limited to one spot an internal cause is unlikely, though.
For the insulating layer of the small skin nerves. A lack causes sensations of its own and makes this spot more sensitive — it is one of the few contributions that can be put right.
An empty store lowers the itch threshold throughout the body. That does not explain the spot, but it explains why it is worse in some months than others.
For the muscles these nerves pass through. With tension between the shoulder blades a lack is a possible contribution — the exercises do more.
Dry skin lowers the itch threshold further. That does not remove the cause, but it takes away an amplifier.
The itch does not sit in the skin but in the nerve that supplies it — which is why the spot mostly looks normal and why anti-itch ointments barely work. What helps is aimed at the nerve and at the thoracic spine it comes from.
The best studied local treatment here. It exhausts the messenger substance in the nerve fibre — that takes four to six weeks several times a day, and in the first days it burns distinctly. Stopping too early gives only the burning and not the effect.
Not as a treatment but for the distinction: a B12 deficiency likewise makes burning, tingling odd sensations — only mostly on both feet and hands, not on one patch at the shoulder blade. The distribution says more here than any laboratory value.
Clearly effective with proven deficiency, useless without. Take only with a documented deficiency — excess is harmful.
Effective when deficient; effects on sleep and stress plausible but moderate. Too much causes loose stool.
The itch sits in a place one can barely reach, and the skin there darkens over the years. It comes from the pinched skin nerve, not from the skin — which is why anti-itch creams work so poorly here.
The itch comes from a pinched nerve at the thoracic spine, not from the skin. Exercises for the thoracic spine improve it in some — ointments usually do not work.