Notalgia paraesthetica – Ein Review mit Fallbeispiel

Zusammenfassung

Notalgia paraesthetica ist eine relativ häufige periphere sensorische Neuropathie, die mit Juckreiz, Schmerzen, Hyper- oder Hypästhesie einhergeht. Sie tritt lokalisiert unilateral am medio-caudalen Schulterblatt auf und hält meist Jahre an. Die Haut kann rötlich-bräunlich, lichenifiziert erscheinen oder ohne Effloreszenzen.

Als Ursachen werden Irritationen der R. dorsales der Spinalnerven Th2 – Th6 durch Traumen, Degeneration u. ä. postuliert, die bildgebend abzuklären sind. Auch erhöhte Neuropeptide werden diskutiert. Die Therapie ist schwierig und langwierig. An erster Stelle stehen die Therapie der orthopädischen Veränderungen und lokale Therapien mit den üblichen antipruriginösen Substanzen. Auch Calcineurin-Inhibitoren, Capsaicin und Cannabinoid-Rezeptor-Agonisten wirken, jedoch ist mit Rezidiven zu rechnen. Systemische Therapien umfassen verschiedene zentral schmerzmodulierende und antidepressive Medikamente, daneben Botox, UVB oder auch elektrische Stimulationen.

Abstract

Notalgia paresthetica shows pruritus localized unilateral to the inferomedial area of the scapula with pigmented plaques, but often without skin lesions. Usually it lasts some years with relapses. The cause seems multifold. Spinal and muscle abnormalities may impinge the spinal nerves Th2-Th6 resulting in this kind of sensory neuropathy. Increased neuropeptides may also be involved. No evidence-based therapy is known, but a variety of case reports exist. Local treatment includes usual antipruritic ointments, UVB, botox, capsaicin and cannabinoid-receptor-agonists. Systemically mostly antidepressives, special pain killers or anticonvulsives are used. There seems to be no association with any general neuropathy.

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