Treatment of notalgia paraesthetica with an 8% capsaicin patch

Abstract

Funding sources: none. Conflicts of interest: none declared. Madam, Two patients with severe pruritus on the upper back were referred to our outpatient pruritus clinic. The first patient, a 73‐year‐old woman, was diagnosed with an atypical form of notalgia paraesthetica (NP) presenting with prurigo nodularis‐like skin lesions in two symmetrical paravertebral hyperpigmented maculae with intense itching (Fig. 1a). An X‐ray revealed a herniated vertebral disc in the cervical spine, matching the affected dermatomes. The second patient was a 61‐year‐old woman with NP complaining of intense itch located in the right mid‐scapular region. She presented with a hyperpigmented, mildly erythematous macula in the area of the pruritus. Radiological examination revealed kyphosis and spondylitis of the thoracic spine. Both patients had multiple previous topical and systemic treatments. We decided to treat both patients for 60 min with Qutenza® (NeurogesX, Inc., San Mateo, CA, U.S.A.), an 8% capsaicin patch. The first patient tolerated the patch for only 20 min because it became too painful. The second patient tolerated the patch well, with a mild to moderate burning sensation throughout the application time and for a further 30 min. Capsaicin treatment is known to lead to stinging and burning, therefore the area of contact with the 8% capsaicin patch has to be pretreated with EMLA® (AstraZeneca, London, U.K.). The most likely reason for the painful sensation in the first patient is that there were some erosive lesions in the pruritic areas. Although we anticipated that this could be a limiting factor (and informed the patient accordingly), the patient was willing to proceed.