Dermoscopy of notalgia paresthetica
Subrata Malakar1, Purva Mehta2, Surit Malakar3
1Medical Director, Rita Skin Foundation, Kolkata, India; 2Consultant Dermatologist, Rita Skin Foundation, Kolkata, India; 3Consultant Dermatologist, Rita Skin Foundation, Kolkata, India
Corresponding author: Dr. Purva Mehta, E-mail: purvamehta86@gmail.com
Submission: 24.09.2018; Acceptance: 13.12.2018
DOI: 10.7241/ourd.20193.31
Cite this article: Malakar S, Mehta P, Malakar S. Dermoscopy of notalgia paresthetica. Our Dermatol Online. 2019;10(3):317-318.
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© Our Dermatology Online 2019. No commercial re-use. See rights and permissions. Published by Our Dermatology Online.
Sir,
A middle aged female complained of certain sensations on the back in the subscapular region. On clinical examination, there was a circumscribed, hyperpigmented patch. A provisional diagnosis of notalgia paresthetica was made (Fig. 1). Dermoscopy was performed using a Dermlite DL3N at 10x magnification under polarised light.
Dermoscopy of this patch revealed alternating patches of hyperpigmentation and hypopigmentation (Fig. 2a). The hyperpigmented patches were brown to slate gray in colour and were present in various forms. They were arranged in an irregular net like pattern. In some areas the pigmentation was scattered with various patterns around a central hub which was either hypopigmented or hyperpigmented. Shiny white streaks were observed within the hypopigmented patches (Fig. 2b).
Notalgia paresthetica occurs due to nerve root entrapment of T2-T6 rami causing paresthesia resulting in chronic itching and friction. This friction leads to degeneration of keratinocytes and deposition of amyloid fibrils in cases of notalgia paresthetica. Amyloid fibrils are abnormally polymerised cytokertain derived material. These fibrils are birefringent and under polarised dermoscopy appear as shiny white streaks [1]. Thus, shiny white streaks in notalgia paresthetica correspond histologically to amyloid fibrils [2]. Hyperpigmentation of various patterns seen dermoscopically corresponds to either basal pigmentation of the epidermis or melanophages with pigment incontinence in the dermis.
Due to its presentation, notalgia paresthetica may mimic macular amyloidosis not only clinically but also dermoscopically. However, shiny white streaks are absent in macular amyloidosis on dermoscopy providing a vital dermoscopic clue in differentiating the two conditions.
Consent
The examination of the patient was conducted according to the Declaration of Helsinki principles.
REFERENCES
1. Arnold S, Bowling J, 'Shiny white streaks’in lichen amyloidosis: A clue to diagnosisAustralas J Dermatol 2012; 53: 272-3.
2. Shin J, Kim YC, Neuropathic Itch of the Back: A Case of Notalgia ParestheticaAnn Dermatol 2014; 26: 392-4.
Notes
Source of Support: Nil
Conflict of Interest: None declared.
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