BRACHIORADIAL PRURITUS
Luciano Schiazza M.D.
Dermatologist
Via Cesarea, 17/4
16121 Genova - Italy
tel. 010.590270 - cell. 335.655.97.70
www.lucianoschiazza.it
Brachioradial pruritus is an intense itching (but also burning) sensation of dorsolateral aspect of either or both arms (corresponding to the brachioradial muscle region), attributed to a nerve damage (neuropathy or radiculopathy).
No erythema or skin eruption is seen in the area of scratching. Excoriation
Whites appear to be affected more often than dark-skinned people.
The itch tipically worses at night, and may interfere with sleeping. Scratching (sometimes the itch can be so intense that people scratch their own skin to a bleeding condition) makes the disconfort worse. Application of ice or cold packs provides symptomatic relief: it is almost pathognomonic for this condition (ice-pack sign).
BRP has been reported in tropical and subtropical areas, less frequently in temperate climates.
Its etiology is unknown but two are the possible hypotheses:
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Prolonged sunlight exposure (the outer parts of the arm tend to receive more sun than the inner parts)
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Radiculopathy due to compression of cervical nerve roots
Whether these associations are causal or coincidental is speculative but if they are not triggering they are at least aggravating factors.
People affected by BRP and live in tropical and subtropical area should wear long-sleeved shirts when outdoors, restricting their time outdoors during peak sunlight hours (10 am to 3 pm).
Treatment of BRP is usually not satisfactory: oral or topical corticosteroids, oral antihistamines.
Numerous treatments have been tried:
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cooling lotion
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topical anesthetic creams,
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capsaicin cream,
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antianxiety agent (topical doxepine)
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antidepressant, tricyclic (amitriptyline)
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antipsychotic (pimozide, risperidone)
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thalidomide (drug useful to treat photosensitive diseases such as discoid lupus erythematosus, polymorphic light eruption, actinic prurigo)
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acupuncture
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Cervical spine manipulation
Because sun exposure could exacerbate this pruritus, patients with brachioradial pruritus need photoprotection.
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