Q: I have had discomfort on my skin on the top of my breast and under my right arm where my bra sits. There is no rash, redness or any sign of anything. A dermatologist called it notalgia paresthetica and gave me this diabetic foot cream made from peppers. I tried it for a while but when the weather got warm, the cream gets hot and the area gets red and burns so I don’t use the cream anymore. I put a tissue under my bra to help ease the pain/itch caused from my clothing on that area. I have had this for over a year. What is your take on this?

A: Notalgia paresthetica (NP) is a neuropathic syndrome presenting on the skin of the mid back. In fact, if you were to reach behind you to scratch the area, it would commonly be just out of reach. This common disorder may present with pain, burning, tenderness, and small red, tan or excessively bright pigmented skin patches thought due to scratching of the area. Many patients with the condition have a history of neck pain or spasms, neck injuries, prior neck trauma such as that from a motor vehicle accident, fractured vertebra, or interscapular pain. Secondary skin changes including eczema and infection may be observed. The condition is most commonly observed in adults between the ages of 40 and 80. It is not life threatening and conditions can subside and exacerbate.

Treatment therapies include TENS (transcutaneous electrical nerve stimulation), EMS (electrical muscle stimulation) of the neck, spinal manipulation, physical therapy, massage, cervical traction, oral NSAIDs (non-steroidal anti-inflammatory drugs, and more. BOTOX has been reported as being successful in the treatment of notalgia paresthetica. Research has determined that topical treatments such as the one you discontinued may be soothing but are rather ineffective and unsatisfactory in reducing symptoms.

While the etiology remains unclear, the likely mechanisms include neuropathy from degenerative cervical/thoracic disk disease or nerve impingement, or localized sensory innervation of the affected areas of skin. A collective bundling of specialists that includes a dermatologist, neurologist, pain management specialist, physical therapist and more may be necessary to cover all the bases and bring you some relief if NP is your true diagnosis.

Your pain isn’t in the normal location for the condition described above and you don’t have a rash, so while I don’t question your physician, I would feel better if you were to get a second opinion. Is there a possibility you are wearing poorly fitting undergarments that exacerbate your symptoms? Lots of women are known to place tissues under the bottom elastic to cushion the area and relieve discomfort. Or, you might have mastalgia, breast tenderness and burning pain that waxes and wanes. You don’t indicate whether you are on any medication such as a diuretic that might cause similar symptoms, nor do you indicate your age. If you are somewhere in the 30 to 50 age range, you might have hormonal changes going on, shingles, costochondritis, and other causes for your discomfort. Both of these latter possibilities can be treated. Did your last mammogram reveal any abnormalities that might lead you to another diagnosis?

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