Concurrent notalgia paresthetica and brachioradial pruritus associated with cervical degenerative disc disease

Notalgia paresthetica (NP) is a common, often refractory sensory neuropathic syndrome with the hallmark symptoms of localized pruritus and dysesthesia of the unilateral infrascapular region. Brachioradial pruritus (BRP) is similarly classified as a localized pruritus syndrome but of the upper extremities, typically one or both forearms. Notalgia paresthetica and BRP are both generally chronic, nonlethal, incurable conditions with intermittent remissions and exacerbation. Often described as dermatologic syndromes, both diseases are typically considered to be multifactorial in etiology with an uncertain etiology. However, recent literature suggests that it is highly probable that NP in many, if not nearly all cases, has an association with underlying cervical disease at the C5-C6 levels. This elucidation has resulted in a paradigm shift in evaluation and treatment of NP as cervical disease with referred skin manifestations to the mid back. Notalgia paresthetica and BRP may occur concurrently in the same patients. To determine possible underlying cervical spine disease, it is vital to examine the neck and consider radiographic studies of the spine. Collaborative multispecialty evaluation may be indicated in primary management of these two conditions. For cases of NP and BRP that are associated with cervical disease, the first-line therapy may include nondermatologic spinal treatments. Many cases of NP and BRP are most likely dermatologic signs of underlying degenerative spine, disc, and muscle disease.

Muir-Torre syndrome: case report and review of the literature

Muir-Torre syndrome (MTS), a subtype of Lynch syndrome II, presents as at least one internal malignancy associated with at least one sebaceous skin tumor. This autosomal-dominant genetic disorder is thought to arise from microsatellite instability. Although not all patients with sebaceous tumors have MTS, even a single biopsy-proven sebaceous adenoma may warrant evaluation for MTS. We report the case of a 76-year-old man with a marked family history of colon cancer; a personal history of colon cancer status post-partial resection of the colon; and multiple cutaneous neoplasms including sebaceous adenomas, sebaceous gland hyperplasia, and basal and squamous cell carcinomas. We review the literature describing MTS and highlight the important role of dermatologists and dermatopathologists in the potential early detection and initial diagnosis of this familial or hereditary colon cancer in patients presenting with cutaneous sebaceous adenomas. Correct diagnosis may be lifesaving in patients with MTS and their at-risk relatives who would benefit from earlier colonoscopy, tumor surveillance, and potential early cancer detection. Muir-Torre syndrome represents yet another dermatologic symptom of an internal disease.

Notalgia paresthetica associated with cervical spinal stenosis and cervicothoracic disk disease at C4 through C7

Notalgia paresthetica (NP) is a common refractory, sensory, neuropathic syndrome with the hallmark symptom of localized pruritus of the unilateral infrascapular back. It generally is a chronic noncurable condition with periodic remissions and exacerbations. While the dermatologic syndrome may be multifactorial in etiology, a possible association with underlying cervical spine disease should be evaluated for proper treatment. Collaborative multispecialty evaluation by dermatology, radiology, orthopedic surgery, and neurology may be indicated for primary management of this condition. First-line therapy for NP with associated cervical disease may include nondermatologic noninvasive treatments such as spinal manipulation, physical therapy, massage, cervical traction, cervical muscle strengthening, and oral nonsteroidal anti-inflammatory drugs and muscle relaxants. Notalgia paresthetica may in fact be a cutaneous sign of an underlying degenerative cervical spine disease. We report a case of a patient with cervical spinal stenosis that corresponded directly with the clinical findings of NP.