Botulinum Toxin for the Treatment of Chronic Notalgia Paresthetica: A Case Report

Notalgia paresthetica (NP) is a chronic sensory neuropathy characterized by localized pruritus and dysesthesia of the upper back, typically resulting from thoracic dorsal rami entrapment. Treatment is often challenging, with many patients experiencing only partial relief from topical corticosteroids, antihistamines, or intralesional injections. We present the case of a middle-aged female with treatment-resistant NP who failed multiple therapies, including topical and intralesional triamcinolone. After experiencing persistent daily discomfort affecting her quality of life, she was treated with targeted intramuscular onabotulinumtoxinA (Botox) injections to the symptomatic area. The patient reported substantial improvement in symptoms following the second round of injections. This case highlights the potential role of botulinum toxin as an effective therapeutic option in managing refractory NP, particularly in patients who do not respond to standard therapies.