WHAT LIES BEHIND A SPOT

Introduction: Notalgia paresthetica (NP) is a pruriginous syndrome, the classic location of which is the unilateral infrascapular area. NP can also occur bilaterally. This disease has an increased prevalence; however it remains underdiagnosed and largely unknown by the General Practitioners’ community. Case description: Woman of 46 years old, Caucasian, married, works as a secretary. During a family planning consult, the patient described a hyperpigmented pruriginous macula of about 10 cm in the dorsal region, which started in the form of several punctiform lesions that after scaring changed into hypopigmented macules. She was treated with sertaconazole and Ketopan® without improvement, therefore was referred to a Dermatology consultation. The patient returned to the general practice consultation two days after being examined by the Specialist, and was diagnosed with NOTALGIA PARESTHETICA with the prescription of Neodor® plus avoidance and protection of solar energy. After a month she was revaluated with complete remission of the lesion. DISCUSSION: There are several mechanisms attributed to an increase in sensitivity of the peripheral nerves which is the mainstay of NP. These mechanisms include vertebral compressive degenerative changes such as osteophytosis and osteoarthrosis, vertebral trauma, physical activities with heavy effort to the spinal column and genetic predisposition. As a multidisciplinary disease it is important that it can be diagnosed by the general practicioners in order to provide early treatment and etiologic investigation. It is imperative to perform an imaging study of the spine so the patients can have a Rheumatologic, Orthopaedics or Neurosurgery follow-up, depending on the findings.