Brachioradial Pruritus

Pruritus refers to an unpleasant sensation that causes the need to scratch, commonly called itching by most people. Itching may be localized to a certain area of the body, or can be all over, or generalized. When there is a rash that goes along with the pruritus, the cause is usually easily determined and treated. However, the most difficult cases of pruritus are those without an associated rash. Regardless of the presence or absence of a rash, itching can be debilitating, especially at night when a person is trying to sleep.

Itching and pain are closely related sensations since the same nerves transmit both signals to the brain. When the area of skin is scratched, that same area may become even itchier, leading to more scratching. This is called the itch-scratch cycle. In general, itching can be related to a problem with the skin or another underlying disease of the body. When itching is localized to a particular area of skin, a systemic disease usually does not cause it.

Brachioradial pruritus is a type of itching that classically occurs over the brachioradialis muscle, which extends from the shoulder to the forearm, just below the elbow. This condition most commonly affects middle-aged women living in warm climates, but can also affect men of all ages and people living around the world. The symptoms of brachioradial pruritus include tingling, burning and itching on the top of one or both arms, and can extend to the shoulder and upper back. Scratching the skin often doesn’t relieve the itch, and can actually make the symptoms worse. Many people with brachioradial pruritus notice that the only relief they get from the itching is from the application of ice packs on the affected skin, which is helpful for the diagnosis of the condition.

The cause of brachioradial pruritus is not completely clear but seems to be related to chronic sun exposure as well as cervical spine disease. Chronic exposure to ultraviolet (UV) radiation can lead to the damage of nerve fibers in the skin, which can make the nerves more sensitive to pain and itch sensations. Alternatively, compression of the nerves that exit the spinal cord from the cervical spine in the neck can lead to the symptoms of brachioradial pruritus. Most likely, people with cervical spine disease are prone to the development of brachioradial pruritus, and that chronic exposure to UV radiation is what actually triggers the symptoms.

The symptoms of brachioradial pruritus are difficult to treat. Often, before the correct diagnosis has been made, people have been given various treatments for their itching, including oral antihistamines and topical corticosteroids, neither of which is likely to be helpful. The application of heat, such as with a heating pad, may possibly worsen the symptoms, while the application of ice packs usually relieves the itching temporarily.

The diagnosis of brachioradial pruritus is often made by a dermatologist, usually based on the symptoms, the location of the itching, and lack of response to usual treatments for itching, and the temporary benefit from ice packs. X-rays of the cervical spine may show degenerative disc disease or osteoarthritis, further suggesting the diagnosis of brachioradial pruritus.

Various therapies have been tried for brachioradial pruritus, with mixed success rates. Topical capsaicin cream is the most commonly used treatment, but needs to be used regularly, and can result in skin irritation. Some people have found benefit from cervical spine manipulation performed by a chiropractor. Oral medications that modulate nerve pain have also been used, such as gabapentin, as well as seizure medications such as carbamazepine and lamotrigine.

Learn more about the causes and treatment of itching.