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Brachioradial pruritus

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Brachioradial pruritus

Also known as brachioradial itch

What is brachioradial pruritus?

Brachioradial pruritus is a skin condition where the affected person is troubled by abnormal skin sensations on the outer forearms, upper arms and occasionally on the top of the shoulder.  The affected person may describe the sensations as itching, burning, prickling or stinging.

What does it look like?

Any changes seen in the skin usually result from chronic rubbing and scratching at the affected area. The skin may become thickened and pigmented. There may be breaks in the skin and nodules due to scratching. The affected areas frequently show changes resulting from chronic sun damage.

What causes it?

The condition is due to inflammation in nerve fibres within the affected area of skin.  The inflammation results most commonly from damage to the sensory nerves in the skin caused by chronic sun exposure. Occasionally the nerves are compressed and damaged by changes in the cervical spine as a result of arthritis or age related changes.

The symptoms are often worse after sun exposure and the affected person may report fewer problems or no symptoms in the winter or autumn.

How is it diagnosed?

Brachioradial pruritus is diagnosed by taking a medical history and examining the skin. If the history suggests that spinal abnormities may be the cause, medical imaging such as CT scan and MRI may be needed.

How is it treated?

  • Prevent the condition from worsening
    • In Australia, most cases result from sun damage to sensory nerves and sun protection to prevent summertime worsening is important.
    • Wear long sleeve shirts of tightly woven material that cannot be seen through when held up to the light or UV protection sleeves. Sunscreens can be used when clothing protection is not available.
  • Relief of symptoms
    • The use of ice packs or wet wraps, especially at night, can alleviate the symptoms of intense itching.
    • Sometimes compounded creams containing menthol and camphor that cool the skin can help.
    • Capsaicin cream can alleviate the itch of brachioradial pruritus by reducing the production of inflammation causing compounds by the damaged nerves.
  • Topical corticosteroids – Rarely, a potent topical steroid under cool wet wrap occlusion may be used. Careful monitoring is needed to prevent side effects such as steroid atrophy.
  • Oral medications include antihistamines, gabapentin and pregabapentin (pregabalin) and lamotrigine may be trialled in more resistant cases.
  • TENS (transcutaneous electrical nerve stimulation), botulinum toxin injections, acupuncture and physical therapy have all helped some individuals.
  • Spinal arthritis or anatomical abnormalities may require referral to a rheumatologist or surgeon.

What is the likely outcome of brachioradial pruritus?

The majority of cases in Australia are related to sun exposure. Some cases resolve within a few weeks to months with topical measures and sun protection. Some individuals have waxing and waning symptoms with episodic flare-ups of the abnormal sensations followed by periods when they have no problems.

This information has been written by Dr Davin S. Lim
Updated 19 January 2016

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