Turkiye Klinikleri Journal of Dermatology

.: ORIGINAL RESEARCH
Spinal Pathologies in Patients with Notalgia Paresthetica and Positive Effect of Strengthening Exercises on Itch Relief: Case Series
Notaljia Parestetikalı Hastalardaki Omurga Patolojileri ve Güçlendirme Egzersizlerinin Kaşıntıyı Gidermede Olumlu Etkisi: Olgu Serisi
Semih GÜDERa, Hüsna GÜDERb
aDepartment of Dermatology, Bezmiâlem Vakıf University Faculty of Health Sciences, İstanbul, TURKEY
bDepartment of Dermatology, Maltepe University Faculty of Health Sciences, İstanbul, TURKEY
Turkiye Klinikleri J Dermatol. 2021;31(2):81-5
doi: 10.5336/dermato.2020-80480
Article Language: EN
ABSTRACT
Objectives: Notalgia paresthetica is a subgroup of localized neuropathic chronic itch and is due to a nerve entrapment limited to the corresponding dermatome. Neuropathic itching often includes signs of sensitive skin syndrome (numbness, burning, stinging, tingling, etc.). It does not respond to antipruritic treatments used in other itchy dermatoses. The relationship between neuropathic itching and spinal pathology has been reported in many studies. Degenerative disc hernias may play a role in chronic itching localized to the back, hand, and brachioradial areas. We aimed to remind these patients we encountered in our clinical practice. Material and Methods: The files of 12 patients with notalgia paresthetica who applied to our dermatology outpatient clinic between 2016-2018 were reviewed. Diagnostic criteria are: No primary skin lesions in the affected skin area, the absence of any other itchy skin disease, detection of spinal pathology compatible with the itching area in magnetic resonance imaging, no other history of systemic disease or medication to explain itching. Results: Spinal canal stenosis, herniated nucleus pulposus, dural sac compression, and non-compressive bulging and protrusions were seen as spinal pathology. Itching completely disappeared in one of the four patients who conformed to the program, and the itch severity decreased in the other three patients. Conclusion: It should be kept in mind that itching may be of neuropathic origin in patients with localized chronic itching. Spine strengthening and stretching exercises may be a good option as primary or adjuvant therapy in neuropathic itching due to spinal pathology. Advanced clinical studies are needed.

Keywords: Notalgia paresthetica; neuropathic itch; strengthening exercises; spinal pathology
ÖZET
Amaç: Notaljia parestetika, lokalize nöropatik kronik kaşıntının bir alt grubudur ve ilgili dermatom ile sınırlı bir sinir lifi kompresyonuna bağlı olarak gelişir. Nöropatik kaşıntı genellikle hassas deri sendromu belirtilerini de içerir (uyuşma, yanma, batma, karıncalanma vb.) ve diğer kaşıntılı dermatozlarda kullanılan antipruritik tedavilere cevap vermez. Nöropatik kaşıntı ile omurga patolojisi arasındaki ilişki birçok çalışmada bildirilmiştir. Dejeneratif disk hernileri sırt bölgesi, el bölgesi ve brakioradiyal bölgelere lokalize olan kronik kaşıntı gelişiminde rol oynayabilir. Biz bu vaka serisi ile klinik pratiğimizde karşılaştığımız bu hastaları tekrardan hatırlatmayı amaçladık. Gereç ve Yöntemler: Dermatoloji polikliniğimize 2016- 2018 yılları arasında başvuran notaljia parestetikalı 12 hastanın dosyaları retrospektif olarak gözden geçirildi. Tanı kriteri olarak; etkilenen cilt bölgesinde primer bir deri lezyonu olmaması, başka herhangi bir kaşıntılı deri hastalığının olmaması, manyetik rezonans görüntülemede kaşıntı alanı ile uyumlu spinal patolojinin saptanması, kaşıntıyı açıklayacak başka sistemik hastalık veya ilaç öyküsü olmaması temel alındı. Bulgular: Spinal patoloji olarak spinal kanal stenozu, herniye nukleus pulposus, dural kese basısı, kompresif olmayan bulging ve protrüzyonlar görüldü. Egzersiz programına uyan 4 hastadan birinde kaşıntı tamamen kaybolurken, diğer 3 hastada kaşıntı şiddeti azaldı. Sonuç: Lokalize kronik kaşıntılı hastalarda, kaşıntının nöropatik orijinli olabileceği unutulmamalıdır. Omurga güçlendirme ve germe egzersizleri, omurga patolojisine bağlı nöropatik kaşıntının primer veya adjuvan tedavisinde iyi bir seçenek olabilir. İleri klinik çalışmalara ihtiyaç vardır.

Anahtar Kelimeler: Notaljia parestetika; nöropatik kaşıntı; güçlendirme egzersizleri; spinal patoloji
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