What Causes Itching in the Middle of the Back?

Notalgia Paresthetica is a common cause of itching in the middle of the back.

Did you know that 10% of people will develop this intense itch in the middle of their back over their lifetime! I am a dermatologist who is one of the 10%.

Many of my patients also have this back itch, and it makes them crazy. Typically, I can see exactly where they itch because the spot has a darkening of the skin indicating that they have reached back and scratched there for years.

Why does my back itch in the same spot all the time? Notalgia paresthetica! 

The recurring itch in the same spot on the back is usually between the spine and one of their shoulder blades. The itchy area is well localized and usually about the diameter of a tennis ball. When anything touches the skin, it starts the itching. This includes fabric, a tag in a garment, the clasp on a bra, or simply the scales of dry skin. My itchy back spot is on the right side between my spine and shoulder blade – argh – I am going to share with you how to help control the itch!

This itchy phenomenon is called notalgia paresthetica, and there hasn’t been agreement on what causes it until now. 

It’s now agreed that notalgia paresthetica is caused by nerve impingement in a spinal nerve.

As the nerve exits the spine, a small branch curves around to innervate the skin. It travels through the back muscle to reach the skin, and on its journey, it gets squeezed. The squeeze usually happens in or around the spine due to abnormal spinal structure that causes secondary muscle tightening.

It doesn’t necessarily mean there is anything severely damaged in the spine. The impingement can come from something as simple as a spinal calcified spur, which we all get as we age. It’s why this frustrating mid-back itch comes with age.

Itchy back causes – when you have an itch that happens at a spinal level it’s called neuropathic itch, or more precisely, neuropathic pruritus.

The skin is normal and not the cause. It’s simply “downstream” from the problem, and you perceive it as the itchy spot. The “downstream” skin is hypersensitive because its nerve is “tweaked.” This means that minor sensations, like dry skin scales, can set it off. It can also be triggered by rough clothing, scratchy tags on garments, etc.

The best treatment, in my dermatologic opinion, is to keep the itchy back skin very well hydrated and free of scale. This is done using a strong alpha hydroxy acid containing moisturizer. 

The best professional AHA for the job of removing scale and smoothing skin surface texture is glycolic acid. This AHA loosens dead skin flakes to polish skin to a smooth surface that is less likely to be itch-generating. I know that the best way to beat an itchy back is with my Ultra-Fast Triple Action Body Smoothing Kit. I use it for my own notalgia paresthetica and I can’t manage without it. If I don’t pack these products when I travel, I regret it because my back ITCHES something fierce!

This kit contains a professional strength glycolic acid body lotion to polish and hydrate itchy and scaly skin. Together, the products remove dead skin scale that acts like tiny feathers to start-up the mid-back itch. Go even one step further by wearing only soft fabrics on this part of your skin and remove those itchy clothing tags.

The other simple but essential item is to get a back lotion applicator to really douse the itchy spot with the Glycolic Acid Body Lotion. I have the best back lotion applicator – because this really matters to my sanity. Trust me, when you scrub your skin with the Salux Cloth and Triple Action Cleanser and then follow up with the back applicator and the Glycolic Acid Lotion you will thank me! This vexing itch is crazy-making, my patients and I are here to share your frustration.

Use an ice pack to stop the itch when your back itch is really bad.

This is a simple intervention when the itch is screaming. Usually, the Ultra-Fast Triple Action Kit and wearing soft fabrics keeps the itch down but there are still times when it sneaks through. The next step is to throw an ice pack on the itchy back skin.

Ice sends a very loud temperature message up the poor little impinged nerve and this really does override the itch message. Think of it like the way loud music drowns out your conversation at a concert. Temperature and itch travel on the same nerve pathway (thank goodness) so we can use cool to override itch.

Don’t use heat; it will actually increase the itch because of its local effect on the skin.

Do not scratch your back itch because it makes it worse.

Scratching is much less effective than an ice pack at giving you relief for notalgia paresthetica. Plus, it will cause your skin nerves to thicken up over time, and thick nerves can send even louder itch messages. When I see a darker tan color on the itchy area of my patient’s skin, it tells me that they’ve resorted to scratching and that the nerves have probably thickening up. – Dermatologist Dr. Cynthia Bailey

The last tip for itchy back is that a prescription cortisone cream may give some relief when the itching is relentless. Ask your doctor if you think this might help you. There are also oral medicines that doctors use for neuropathic pruritus. Most of these medicines have complex side effects, so they are a last resort and any discussion of them needs to happen with your doctor.  Some people have found relief with complementary therapies such as acupuncture, massage and biofeedback. These are safer options than the oral medications and I’ve found that these modalities can work for some people.

Click here to see my Ultra-Fast Triple Action Body Smoothing Kit and experience the relief that I get from the itch in the middle of our backs!