Alleviation of notalgia paresthetica with duloxetine after several lines offailed treatment: A case report

Chronic pruritus affects up to 20% of the population; about 8% of patients suffer from neurogenic pruritus, including notalgia paresthetica (NP). This is a syndrome of benign, chronic itch of the unilateral medial border of the scapula of unknown etiology and limited treatment efficacy. Here we report the background on NP, followed by a classic case presentation of a 63-year-old woman. We report on difficulty in her diagnosis and numerous failed lines of treatment, until initiation of treatment with duloxetine, which provided her with long-lasting benefit for the first time. Delay in diagnosis is common for NP, and though there are many options for treatment, evidence is lacking to support their efficacy. Finding an effective, well-tolerated regimen to alleviate long-term suffering brought on by this syndrome is heavily dependent on early identification. Our case provides anecdotal evidence for both treatment efficacy as well as the etiology of this poorly understood phenomenon.