Most Common Location of Notalgia Paresthetica
Notalgia paresthetica most commonly affects the unilateral infrascapular region of the upper back, specifically in the area corresponding to the T2-T6 dermatomes, typically located medial or inferior to the scapulae. 1, 2
Anatomical Distribution
The characteristic location is a well-demarcated area between the T2 and T6 dermatomes on the back, which corresponds to the region innervated by the posterior rami of thoracic spinal nerves 3, 2
The condition typically presents as a unilateral infrascapular distribution, though the exact side can vary between patients 4, 5
The affected area is most often positioned medial or inferior to the scapulae, creating the classic presentation that helps distinguish this condition from other causes of back pruritus 1
Clinical Presentation at This Location
Patients develop a hyperpigmented macule or patch at the site of symptoms, which serves as a visible marker of the affected dermatome 1, 2
The localized pruritus is the hallmark symptom, often accompanied by pain, burning sensations, paresthesias, surface numbness, and tenderness confined to this specific anatomical region 5, 2
Pathophysiological Correlation
The consistent T2-T6 dermatomal distribution supports the theory that notalgia paresthetica results from sensory neuropathy caused by damage to posterior rami of thoracic spinal nerves at these specific levels 3, 2
Spinal imaging often reveals dorsal arthrosis or spinal static disequilibrium at corresponding vertebral levels in the majority of patients, with cervical spinal stenosis and cervicothoracic disk disease at C4-C7 potentially contributing to symptoms through nerve compression 4, 3