NUMBNESS OF THE BACK
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A patient of mine has been complaining off and on for a year about 
"numbness" in an area of her midback. I could never see anything and 
she was not scratching it . This week I happened to see her back and 
noticed a faint color variation in the same general area. An irregular 
patch of shiny ,slightly hyperpigmented skin was evident in her mid 
right back. There was no real induration but the texture was clearly 
different. Upon pinprick exam sheshowed no numbness but did report 
decreased sensation in that area alone. The patient is otherwise 
completely healthy and asymptomatic. 

Does Morphea or LS&A start with this type of  parasthesia?

Any other ideas?


Marty Kay MD
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Marty, I would at least consider biopsing the border of the lesion to 
look for red snappers with that presentation, particularly if there 
has been a history of foreign travel or travel to endemic areas of 
the US (like Texas and Louisiana). Armadillos in that part of the UScan 
carry and apparently transmit the Hansen's bacillus. More likely though,
you are right, it is probably morphea, LS&A, cutaneous lupus or even 
something as simple as a dermatophyte (I seem to get burned on that 
one at least once or twice a year). 

Mark Naylor, M.D.
Fleishaker Assistant Professor for Dermatology Research
Center for Molecular Medicine
-----------------------------

I agree re Dx.  Zostrix has been disappointing.  Not too mention Sarna, 
Zonalon, and Doxepin.  Has any one found and effective tx for notalgia 
paresthetica?

Dan Mitchell, MD
Charleston, SC
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Re itchy inapparent areas of the back, usually paraspinal @ ~ t4-6, I 
agree with Dr Fishman--I'll bet it's Notalgia Paresthetica, what-ever 
that is.  I think it's pretty common, as is Meralgia Paresthetica: 
similar itching/paresthesia of lower lateral thigh.
 

Mike Eichwald MD
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				4.17.96