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The Best of the Best
November 15, 2010

Top-Accessed Article: Notalgia Paresthetica Treated With Botulinum Toxin Type A

Arch Dermatol. 2010;146(11):1299. doi:10.1001/archdermatol.2010.285

Weinfeld PK. Successful treatment of notalgia paresthetica with botulinum toxin type A. Arch Dermatol.2007;143(8):980-982.

Notalgia paresthetica is a form of entrapment neuropathy involving the posterior rami of spinal nerves T2 to T6. In a few cases, it is resistant to conventional therapies, and the itch significantly impairs the patient's quality of life. Weinfeld reported using a novel treatment consisting of botulinium toxin type A in doses ranging from 16 to 48 U in 2 patients with persistent notalgia paresthetica. Four units of the toxin were injected intradermally in several points along the involved dermatomes. Interestingly, in both cases, its effect for this condition lasted longer than its effect for muscular contractions and glandular secretions. The rationale for the use of botulinum toxin type A is that it inhibits the release of acetylcholine and neuropeptides such as substance P and glutamate, which are involved in neuropathic itch. This anecdotal report holds promise as a novel approach to the treatment of other forms of neuropathic itch.

From June 2004 through August 2009, this article was viewed 2866 times on the Archives of Dermatology Web site.

Contact Dr Yosipovitch at the Department of Dermatology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157 (gyosipov@wfubmc.edu)