What is Brachioradial Pruritus?
Brachioradial pruritus or BRP is a condition that causes strong itching or a strange sensation on the upper arms, specifically towards the back (See Image: Brachoradialis Pruritus). This condition is often seen in middle-aged white women and is more common during the summer months. It’s thought to be caused by nerve problems in the upper arms, often linked to neck issues, along with exposure to ultraviolet sunlight.
Despite there being many reasons why one’s skin might itch, doctors specializing in skin conditions, or dermatologists, can typically identify BRP easily during a patient examination. In most cases, there’s no need for additional tests like imaging or lab work, or for consultations with other specialists.
There are many treatment options available for BRP and they’re generally well-received by patients. Because BRP usually goes away on its own and is not a serious problem, there have not been many recorded cases, and as a result, not many studies on this condition.
What Causes Brachioradial Pruritus?
Brachioradial pruritus is a condition where you feel an itchy sensation in your arm. Researchers believe that it likely occurs due to a combination of two things: irritation of neck nerves and sun damage to the affected area.
Most people who get diagnosed with brachioradial pruritus have abnormalities in their neck spine which show up on imaging scans like X-rays, CT, or MRI. These scans can reveal issues like worn-out joints from osteoarthritis, pressure on neck nerves due to a slipped disc, or narrowing of the passages where nerves exit the spine. These conditions are most common in the areas of the spine that can affect sensation in the arms, specifically from the 5th to 8th cervical vertebrae.
However, it is important to note that not everyone who has these neck spine abnormalities has symptoms of nerve root irritation (radiculopathy) and not all patients diagnosed with brachioradial pruritus undergo imaging. This implies that the presence of neck spine abnormalities in patients with brachioradial pruritus might simply be a coincidental finding.
Sun damage (UVR) is also thought to contribute to brachioradial pruritus. Many patients seem to experience worse symptoms during sun exposure, with some even referring to the condition as “summer itch”. The idea is that excessive sunlight can harm certain nerve fibers that help transmit itchiness (C-fibers). Despite a decrease in skin nerve fibers, itchiness can increase in patients facing brachioradial pruritus due to sunlight exposure. This abnormal itching sensation to a stimulus that does not normally cause itchiness is referred to as alloknesis. Many people find their symptoms get better during winter or if they use sun protection, which aligns with the idea that sun damage can be a trigger for this condition.
The presence of cervical nerve irritation or sun damage isn’t required to diagnose brachioradial pruritus. This means even if these factors are not obvious through imaging or skin damage, you might still have brachioradial pruritus if the symptoms match.
Risk Factors and Frequency for Brachioradial Pruritus
Brachioradial pruritus was thought to be more common in males based on early individual case studies. However, recent larger studies show that it is more commonly found in females than males, with a ratio of 3:1. The condition is most often diagnosed around the age of 59, but can occur at any age. Brachioradial pruritus is prevalent in people with lighter skin, especially those with Fitzpatrick type I and type II skin, as opposed to those with darker skin types. This supports the theory that Ultraviolet Radiation (UVR) plays a role in causing brachioradial pruritus.
- Brachioradial pruritus was initially thought to be more common in males.
- Recent studies show it’s more common in females, with a ratio of 3:1.
- The average age for diagnosis is 59, but it can happen at any age.
- People with lighter skin, particularly Fitzpatrick type I and II, are more likely to have this condition.
- These facts suggest that Ultraviolet Radiation (UVR) could be a factor in the onset of brachioradial pruritus.
Signs and Symptoms of Brachioradial Pruritus
Pruritus, or itchiness, can have many different causes, so it’s important to take a detailed history to avoid misdiagnosis and unnecessary testing. One specific type of pruritus is Brachioradial pruritus which mainly affects the outer, upper part of the arms, but can also extend to the shoulders and neck. These areas correspond to the C5 and C6 nerves in your spine. Along with itchiness, people may also feel pain, a stinging sensation, or tingling in the affected areas.
About three quarters of the time, Brachioradial pruritus affects both arms. People typically experience symptoms for 2 to 3 years before a diagnosis is made. It often occurs in people who spend a lot of time outdoors, like bikers, hikers, or those who tan frequently, and these individuals may have a history of sunburn. It’s also worth noting that while many patients with Brachioradial pruritus have abnormalities in their neck spine seen on scans, very few of them actually complain of neck pain, neck trauma, or a narrowing of the neck spine.
When a doctor examines the skin in the affected areas, they usually don’t find any major skin changes that would explain the itchiness. However, because of frequent scratching, secondary skin changes like scratch marks, bumps, or thickening of the skin may be present. Sometimes, the situation can be complicated by other chronic itchy conditions, skin diseases, the use of certain creams or other medications, or unusual symptom presentations.
Testing for Brachioradial Pruritus
The “ice-pack sign” is a key indicator of a condition known as brachioradial pruritus. This is a simple test where an ice pack is placed on the area where you’re itching. If your itching gets better immediately but comes back as soon as the ice pack is removed, this is a strong sign of brachioradial pruritus.
Usually, no other tests are necessary apart from this ice-pack test, along with a detailed discussion of your symptoms and a physical exam. However, in persistent cases, further checks might be necessary. These could be imaging tests (like x-rays, CT scans, or MRIs), blood tests, or consultations with experts in relevant fields.
Imaging tests like x-rays, CT scans, and MRIs generally aren’t necessary. But if there is a need to look at your cervical spine (the part of your spine in your neck), MRI is the preferred method. You might also have blood tests to look for the cause of your chronic itching. If the doctors think there might be a neurological cause – in other words, a cause related to your nerves – they might refer you to a neurology specialist. This could involve more tests, like getting images of your cervical spine or a test called electromyography (EMG) which is used to evaluate the health of your muscles and the nerve cells that control them.
Treatment Options for Brachioradial Pruritus
The treatment for brachioradial pruritus, a condition causing a persistent itching sensation, includes a combination of avoiding harmful sun rays, using topical treatments, taking medications, and, in certain cases, even surgery. One of the main methods of treatment is to avoid being exposed to harmful sunlight. This can be done by limiting sun exposure, using sunscreen regularly, and wearing long-sleeved clothing that protects against harmful UV rays. However, this may not be easy for everyone, especially those who enjoy outdoor activities during the warmer months.
Topical treatments applied directly to skin affected by brachioradial pruritus include capsaicin, mild steroids, anesthetics, antihistamines, and a combination of amitriptyline and ketamine, which are types of medications. Earlier reports indicated that a chili pepper extract called capsaicin was most commonly used as an initial treatment, but newer studies point to amitriptyline, an antidepressant, as the most commonly prescribed medication. There’s also another medication called gabapentin, which may work even better.
Other medications that may be orally taken for the treatment of this condition are risperidone, fluoxetine, chlorpromazine, and hydroxyzine. However, it’s important to note that for reasons not fully understood, typical allergy medications (antihistamines) are not effective in treating brachioradial pruritus. The response to treatment tends to be highest in patients who consider their itching to be severe and those who stick with their treatment over a longer period.
Do note that most studies involve a small number of patients, and there are varying opinions on which treatment works the best. Finally, surgery is only considered for patients who have an identifiable neck spinal issue, which can be determined through medical imaging. Very few patients fall into this category.
What else can Brachioradial Pruritus be?
When trying to figure out what’s causing itching in the outer part of your arm and hand (a condition known as brachioradial pruritus), there are a few other possibilities doctors keep in mind. These include:
- Neurotic excoriations (scratches caused by excessive scratching)
- Notalgia paresthetica (a condition that causes an intense itch on your back)
- Zoster sine herpete (a kind of shingles without the rash)
- Atopic dermatitis (commonly known as eczema)
