Brachioradial Pruritus Medication

  • Author: Julianne Mann, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jun 21, 2010
 

Medication Summary

Treatment of brachioradial pruritus remains a challenge. Most patients find relief with the application of cold packs that numb the skin; hence, a positive "ice-pack sign" is almost pathognomonic for this condition.[3] Oral antihistamines and topical corticosteroids are only occasionally of value. If potent or superpotent topical corticosteroids are used, care must be taken to avoid cutaneous atrophy from overzealous use. Occasionally, patients are helped with topical anesthetics (eg, lidocaine cream or gel) or with 5% topical doxepin.

Substance P is a neurotransmitter important in the transmission of pain and itch neural signals. Topical capsaicin cream (0.025-0.05%) is a natural plant product that depletes substance P from cutaneous nerve endings.[30] It has been reported by a number of authors to provide relief of brachioradial pruritus within weeks,[14, 18, 31, 32] although the authors have not found it to be useful in their patients.

Numerous oral medications have been tried with varying success. Case reports describe sustained symptomatic relief with gabapentin (1800 mg/d),[27] lamotrigine (200 mg/d),[7] amitriptyline (25-150 mg qhs),[18] and pimozide (1-2 mg/d). Oxcarbemazepine has proven effective in several patients reported by Savk and Savk.[26] Risperidone has been used with some success in certain patients. No medication works predictably. When using psychotropic medications, obtaining a psychiatric opinion is advisable unless the treating physician commonly prescribes these agents.

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Analgesic, Topical

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Capsaicin topical (Zostrix High Potency, Trixaicin HP, Zostrix Sports)

 

Natural chemical derived from plants of Solanaceae family. Penetrates deep for temporary relief of minor aches and pains of muscles and joints associated with inflammatory reactions. May render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons. Has demonstrated effectiveness in several studies of diabetic neuropathic pain and in other types of neuropathic pain.

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Antianxiety Agent

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Doxepin cream (Prudoxin, Zonalon)

 

A TCA that has potent H1-blocking activity, making it quite useful for urticaria. However, has very potent sedative and anticholinergic effects. Can be quite effective if used at bedtime because the sedative effects can help a patient with pruritus sleep. Widespread use produces sedation, as does use in areas of high percutaneous absorption (eg, genitals). Many individuals develop allergy to topical doxepin.

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Antiarrhythmic Agent, Class I-b

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Lidocaine (Topicaine, Senatec)

 

Decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses

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Anticonvulsant

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Gabapentin (Gabarone, Neurontin)

 

Membrane stabilizer, a structural analogue of the inhibitory neurotransmitter GABA, which paradoxically is thought not to exert effect on GABA receptors. Appears to exert action via the alpha(2)delta1 and alpha(2)delta2 auxiliary subunits of voltage-gaited calcium channels. Used to manage pain and provide sedation in neuropathic pain.

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Antidepressant, Tricyclic

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Amitriptyline (Elavil)

 

Analgesic for certain chronic and neuropathic pain. Blocks reuptake of norepinephrine and serotonin, which increases concentration in CNS. Decreases pain by inhibiting spinal neurons involved in pain perception. Highly anticholinergic. Often discontinued because of somnolence and dry mouth.

Cardiac arrhythmia, especially in overdose, has been described; monitoring QTc interval after reaching target level is advised. Up to 1 mo may be needed to obtain clinical effects.

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Contributor Information and Disclosures
Author

Julianne Mann, MD  Resident Physician, Department of Dermatology, Oregon Health and Science University

Julianne Mann, MD is a member of the following medical societies: Alpha Omega Alpha and Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

David J Elpern, MD  Consulting Staff, The Skin Clinic

David J Elpern, MD is a member of the following medical societies: American Academy of Dermatology and Hawaii Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jacek C Szepietowski, MD, PhD  Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Stiefel GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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Area of pruritus demarcated in pen in a middle-aged woman with brachioradial pruritus. Macroscopically, no skin changes are visible.
Subtle excoriations on the dorsal forearm of a middle-aged woman with brachioradial pruritus.
 
 
 
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