What Is Brachioradial Pruritus?

Another name for itching is pruritus. When itching occurs specifically on the skin between your shoulder to the forearm, it is called brachioradial pruritus, named for the brachioradial muscle that runs between the two joints.

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. 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. Patients who live in colder climates have reported improvement in symptoms during the fall and winter months.

While the exact cause of the condition is unknown, brachioradial pruritus is believed to be due to either cumulative sun damage or nerve root entrapment caused by degenerative spine diseases, such as spinal stenosis, or compression of the nerves that exit the spinal cord from the cervical spine in the neck (as with cervical spondylosis). In fact, it may be a combination of both. 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, leading to the symptoms of brachioradial pruritus. It is believed that chronic exposure to UV radiation is what actually triggers the symptoms in people with cervical spine disease.

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 some cases, the itching can be debilitating, especially at night when a person is trying to sleep.

Brachioradial pruritus is often diagnosed by a dermatologist, usually based on the symptoms, the location of the itching, and the lack of response to usual treatments for itching. 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; this often leads to a definitive diagnosis.

If you have a rash that goes along with the pruritus, it is unlikely you have brachioradial pruritis, which doesn't cause a rash. Hence, if there is a rash, the cause is usually easily determined and treated. The most difficult cases to diagnose are in those without a rash.

Due to the association with spine disease, a dermatologist will most likely order an x-ray of the cervical spine to rule out spine problems that might increase pressure on nerve roots to the arm. X-rays may show degenerative disc disease or osteoarthritis, further suggesting brachioradial pruritus.

The symptoms of brachioradial pruritus can be difficult to treat. Often, people have tried various treatments for their itching, such as oral antihistamines and topical corticosteroids, neither of which is likely to be helpful. Patients may have also sought relief by applying heat to the area—with a heating pad or a hot bath—only to aggravate the condition.

Various therapies have been tried for brachioradial pruritus, with mixed success rates. Topical agents used to improve symptoms are capsaicin cream, pramoxine cream, doxepin cream, amitriptyline, and ketamine cream. Topical capsaicin cream works by decreasing a chemical produced in nerve endings known to cause itching and pain. Topical pramoxine is an anesthetic that works by numbing sensory nerve impulses in the skin. Topical doxepin is an antihistamine cream that decreases chemicals known to cause itching.

Some people have found benefits from acupuncture or cervical spine manipulation performed by a chiropractor. Oral medications that modulate nerve pain, such as gabapentin, as well as anti-seizure medications such as carbamazepine and lamotrigine, are often effective.

Because sun exposure is a known trigger for brachioradial pruritis, it is important to be vigilant about using good sun protection in the areas where symptoms occur.