Got an Itchy Back? Dry Skin Might Not Be the Only Culprit.

Experiencing itching on your back can be an incredibly frustrating experience, particularly when it’s impossible to reach and scratch the affected area. Typically, itching on the back is worst in areas that are out of reach. However, treating the source of the itch is best to avoid constant scratching. The source of the problem may not always be a result of simple dry skin; it could be irritant contact dermatitis or even a sensory neuropathy. This is what you should know about each cause of itching, and how you can treat them.

Simple Dry Skin

Dry skin is the primary cause of itching on the back. In winter, when humidity drops and skin is generally dryer, this condition is far worse. Since the amount of lipids or natural oils in your skin reduces with age, you might feel itchier as you get older. Using humidifiers at home can help you retain your skin’s hydration moisture. However, applying moisturizer regularly is the most effective treatment. Since applying lotion on your back can be tricky, especially if you lack shoulder flexibility, incorporating an extra pair of hands to reach your back with a moisturizer is a great option. However, a simple rubber spatula can be used to extend your reach, ensuring that you can apply moisturizer daily after bathing in order to lock in moisture. Excellent moisturizers include CeraVe Cream or Cetaphil Pro.

Irritant Contact Dermatitis

If the dry skin is left untreated, the skin barrier function can deteriorate, causing irritation with everyday items. In this case, things that come into contact with your back like soaps, cleansers, shampoos, or even sweat can irritate the skin. The way out of this situation is to avoid irritants: take shorter showers, rinse your back thoroughly after shampooing, and hurry to the shower after a workout to prevent sweat from staying in contact with your skin for an extended period. Ensure you dry off and apply your moisturizer immediately. If these tips don’t work, and irritant contact dermatitis has developed, your dermatologist might prescribe a topical steroid to treat it, along with recommendations to avoid irritants and moisturizing.

Notalgia Paresthetica

Notalgia Paresthetica is an unusual itchy patch that develops on one side of your back, just below the shoulder blade, in an unreachable area. It's a form of sensory neuropathy and a common condition that results in paroxysmal itching on a well-defined back skin patch. The itching doesn't have a defined precipitant and often waxes and wanes. Alongside itching, some patients report localized burning, pain, prickling, or numbness in the same area. Under the skin is how patients often describe the itch, referring to the underlying neurologic issue.

Notalgia paresthetica does not appear on the skin itself, but your dermatologists at SkinCare Physicians recognize signs of this condition because of the secondary alterations in your skin associated with chronic scratching and rubbing this particular area. A localized region of thick, hyperpigmented skin is visible just under the shoulder blade on one side of your back, as shown on the right side of the photo.

Notalgia paresthetica on the back

The exact cause of notalgia paresthetica is currently unknown. Osteoarthritis, degenerative cervicothoracic disc disease, or direct nerve impingement may contribute to developing this condition. In one study, more than half of patients had spinal changes visible on x-rays, indicating cervical spine disc disease where the impinged nerves at C4-C6 levels may contribute to development.

Notalgia paresthetica is a neurologic condition that does not result from skin issues. Treating the skin irritation due to scratching may help the secondary effects, but this doesn't resolve the underlying itching sensation resulting from the neurologic issue. Physical therapy, massage, chiropractic manipulation, transcutaneous electrical nerve stimulation (TENS), and acupuncture are among treatments reported to be helpful. Daily application of topical capsaicin depletes substance P, a neural molecule that causes itch or pain. Capsaicin's a natural chemical derived from chili peppers, and it's been shown to be effective in treating several types of neuropathic pain, including notalgia paresthetica. Capsaicin cream can be bought over the counter and applied three times daily to the affected NP area. Just like you'd use a rubber spatula to apply moisturizer, the same can be used to apply capsaicin cream. Just be sure to rinse your hands carefully after applying the cream to avoid getting any in your eyes since it causes a burning sensation.

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