Brachioradial pruritus

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Brachioradial pruritus (sometimes abbreviated BRP) is a skin disorder a form of puritus characterised by an intense itching sensation of the arm usually between the shoulder 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, affluent, 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. In the skin of the lower arm, the number of protein gene product 9.5 immunoreactive nerve fibers was reduced 23% as compared with controls ( P = .03), the number of intraepithelial nerve fibers being reduced by 27% ( P = .03). The number of calcitonin gene-related peptide immunoreactive nerve fibers in the dermis was reduced by 34% ( P = .02) and the number of capsaicin-sensitive nerve fibers by 43% ( P = .008). The innervation of the four patients who were their own controls became normalized during the symptom-free period.

Treatments

The application of an ice pack, chilling the skin to numbness, is sometimes the only treatment that can provide relief. This finding is nearly pathognomonic for this condition.

NUCCA chiropractic adjustments have provided long term relief with minimal number of treatments. However one set of both pre and post x-ray films are needed to prove the actual reduction in the cervical misalignment.

These x-rays are NOT required!  If the cause is cervical nerve-root irritation, manipulation may help but pre/post xrays are pseudoscience and are not required.

Gabapentin; 100mg, 3x per day works for many, Fluocinonide .05% and Purdoxin for topical creams

Treatment with lamotrigine has been reported.

See also

• List of cutaneous conditions

References

• Br J Dermatol 1986;115:177-80.
• Br J Dermatol 1996;135:486-7.
• Dermatology 1977;195:414-5.
• Mann J, Elpern DJ Brachioradial Pruritus, eMedicne.com, June 21, 2010 http://emedicine.medscape.com/article/1355312-overview
• J Am Acad Dermatol 2001;44:704-5
• 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.

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