Brachioradial pruritus

Brachioradial pruritus (sometimes abbreviated BRP) is an intense itching sensation of the arm usually between the wrist and elbow of either or both arms. The itch can be so intense that sufferers will scratch their own skin to a bleeding condition.

The condition is becoming increasingly common, presenting in patients who are usually fair skinned, and middle aged that indulge in golf, tennis, sailing, or other leisure outdoor activities in sunny climates.

The cause is not known, although there are a few lines of thought on what causes it. No cure has been found. Many different medications and types of topical creams have been experimented with, but none seem to make any difference. The only thing that seems to help most sufferers is the application of ice to the area until the itch is diminished.

Causes

Brachioradial pruritus (BRP) is a localized pruritus of the dorsolateral aspect of the arm. BRP is an enigmatic condition with a controversial cause; some authors consider BRP to be a Photodermatosis whereas other authors attribute BRP to compression of cervical nerve roots.

BRP may be attributed to a neuropathy, such as chronic cervical radiculopathy. The possibility of an underlying neuropathy should be considered in the evaluation and treatment of all patients with BRP.

The main cause of BRP is not known but there is evidence to suggest that BRP may arise in the nervous system. Cervical spine disease may be an important contributing factor.

Patients with BRP may have underlying cervical spine pathology. Whether this association is causal or coincidental remains to be determined.

There is controversy regarding the cause of brachioradial pruritus: is it caused by a nerve compression in the cervical spine or is it caused by a prolonged exposure to sunlight?

In many patients, itching of the arms or shoulders is seasonal. Some patients reported neck pain.

Treatments

Chiropractic care has been shown in cases to help with treatment of brachioradial pruritus when applied to the cervical spine.

• BRP Patient Testimonial: Cervical traction with a home device (used in a horizontal body position) seems to relieve some of the pressure on cervical nerves. In addition, Lidocaine 5% patches (manufactured by Watson/Actavis Pharmaceuticals) placed each evening on shoulders and arms have provided significant, beneficial, and effective relief. Patches are worn for 12 hours and help the patient to sleep at night. The benefits seem to carry over into the following day. Lastly, Aspercream with 4% Lidocaine provides on-the-spot short term relief. Effective hygiene includes cool or cold showers with only Cetaphil used on arms and shoulders.

Treatment with lamotrigine has been reported.

Treatment by Acupuncture has been reported.

See also

• List of cutaneous conditions

Further reading

• Dermatology 1977;195:414-5.
• Brachioradial Pruritus at eMedicine
• Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
• Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
• Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
• Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
• DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
• Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
• Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.
• Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fourth Edition. Mosby 2001.