A 42-year-old woman reported that she had been suffering from itching pain in the area of the left shoulder blade for a year before coming to the clinic and shortly afterwards she noticed that she had a hyperpigmented spot on her back, in the mid-dorsal area, but this did not coincide with the pruritic area. The itching sensation was constant, sometimes even with a sensation of "electric shocks". He was bothered by any mechanical stimulus on that area, which prevented him from wearing tight clothing and even avoided any minimal friction. A biopsy of the hyperpigmented lesion was performed and was compatible with the diagnosis of notalgia paraesthetica. The examination revealed an area of hyperaesthesia in the left scapular region, with cutaneous and dynamic allodynia, plus hyperaesthesia on pinprick in a clearly demarcated area. Magnetic resonance imaging (MRI) of the entire spine showed no abnormalities. Various treatments were tried (ebastine, capsaicin cream, topical corticosteroid, oral pregabalin, lidocaine 5% patch, capsaicin 8% patch, botulinum toxin infiltration), with no efficacy on the symptoms described and no improvement in the clinical picture.

