Brachioradial pruritis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Brachioradial pruritis (sometimes abbreviated BRP) is 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 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 has been a 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 all but two of the patients, itching of the arms or shoulders was 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 = 0.03), the number of intraepithelial nerve fibers being reduced by 27% (P = 0.03). The number of calcitonin gene-related peptide immunoreactive nerve fibers in the dermis was reduced by 34% (P = 0.02) and the number of capsaicin-sensitive nerve fibers by 43% (P = 0.008). 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.

References

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  • 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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