Authors: Andreas Moser , Thomas J Feuerstein

Abstract

Background: Notalgia paresthetica is a chronic sensory neuropathy characterized by localized pruritus and associated dysesthesias. There exists no definitive treatment for the disease to date. Here we report a novel concept of dopaminergic treatment in a female patient with chronic itching due to a probably hereditary form of notalgia paresthetica.

Case Presentation: We describe a 76-year-old female patient suffering from severely distressing notalgia paraesthetica. Here, itching occurred mainly during the cold season in the area medial to the left scapula. Notably the patient’s mother, uncle and cousin were also affected by the disease. Low dose treatment with levodopa 50 mg combined with benserazide 12.5 mg per day significantly reduced itching with additionally alleviating the compulsive urge to scratch.

Conclusion: The neurobiological difference between A11 and A10 dopaminergic (DAergic) neurons may explain the efficacy of levodopa at low dosages. Absence of the dopamine transporter system (DAT) in A11 DAergic neurons, contrasted with functional DA reuptake in A10 DAergic neurons. These neuronal differences may lead to a more complex modification of intra- and extracellular DA with spinal inhibitory effects on itch signals without increasing reward-related mechanisms. Thus, this report gives evidence for a novel treatment concept with low-dose levodopa in notalgia paresthetica.

Keywords: Notalgia paresthetica, itching, levodopa, dopamine, dopamine transporter, A10/A11 neurons.