What is brachioradial pruritus? How is it be treated?

What is brachioradial pruritus?

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

Symptoms of brachioradial pruritus

Symptoms of brachioradial pruritus include stinging, burning, and itching on the top of one or both arms, and may extend to the shoulder and upper back. Scratching the skin often does not relieve the itchiness and can even make symptoms worse. This condition most commonly affects middle-aged women living in warm climates, but it can also affect men of all ages and people living around the world. Patients in colder seasons have some improvement in symptoms during the winter months.

What are the causes of brachial itching?

Although the exact cause of this condition is unknown, it is believed that brachioradial pruritus is either due to cumulative sun damage or nerve root blockage caused by degenerative diseases of the spine, such as spinal stenosis, or compression of the nerves exiting the spinal cord at the nape of the neck (as in the case of cervical spondylosis). In fact, it can be a combination of the two. Chronic exposure to ultraviolet (UV) rays can damage nerve fibers in the skin, which can make the nerves more sensitive to pain and itchy sensations, leading to the symptoms of brachioradial pruritus.

Since the similar nerves carry both sensation signals to the brain. So sensations such as itching and pain are very closely related. When the skin is scratched, that same area can become even more itchy, resulting in more scratching. This is referred to as the itch-scratch cycle. In some situations, at night when a person feels asleep itching sensations can be debilitating.

When neck pain may be due to osteoarthritis

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How is brachioradial pruritus diagnosed?

Brachioradial pruritus is often diagnosed by a dermatologist, usually on the basis of the symptoms, the location of the itching, and the lack of response to usual treatments. Most of the people having brachioradial pruritus show only relief they get from itching is applying ice packs to the affected skin; this often leads to a definitive diagnosis.

If you have a rash that accompanies the itching, you’re unlikely to have brachioradial pruritus, which doesn’t cause a rash. Therefore, in the event of a rash, the cause is usually easy to determine and treat. The most difficult cases to diagnose are those without a rash.

Due to the association with spinal disease, a dermatologist will most likely order an x-ray of the cervical column to rule out spinal issues that could increase pressure on the nerve roots in the arm. X-rays may show degenerative disc disease or osteoarthritis, which also suggests brachioradial pruritus.

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What is the treatment for brachioradial pruritus?

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, which are not likely to help. Patients may also have sought relief by applying heat to the area – with a heating pad or a hot bath – only to make the condition worse.

A variety of 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 be itchy.

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

Since sun exposure is a known trigger for brachioradial pruritus, it is important to ensure that you use good sun protection in areas where symptoms occur.

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