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Brachioradial Pruritus Treatment & Management

  • Author: Julianne Mann, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Aug 12, 2016
 

Medical Care

Patients with brachioradial pruritus need time, sympathy, and understanding. They appreciate being told that they have a defined entity and that treatment options are available. Ice packs are helpful for immediate symptomatic relief, and other treatments can be tried in an outpatient setting. Frequent follow-up is often helpful emotionally for patients. Most cases remit in weeks to months.

Cervical nerve blocks have been reported to be unhelpful,[8] but cervical spine manipulation is effective in some patients.[1, 24] Cutaneous field stimulation has also been used. In one study, patients receiving 20 minutes of this treatment to affected areas once daily reported significant symptomatic improvement after 5 weeks.[34]

Acupuncture may be helpful for symptomatic relief. Stellon[35] performed a retrospective case series of 16 patients with brachioradial pruritus using deep intramuscular stimulation acupuncture to the paravertebral muscles in the dermatomal segments of the body affected by the pruritus. Treatment was also given to other segments of the body not affected by the pruritus if paravertebral spasm and tenderness was detected. After a median of 4 treatments, 12 of 16 patients reported complete resolution of symptoms and 4 patients reported partial resolution. Relapse occurred in 6 patients within 1-12 months of cessation of acupuncture.

One report describes dramatic improvement after injections with botulinum toxin A (100 IU/3 mL saline) in a 59-year-old white woman with longstanding brachioradial pruritus.[36] This patient received 4 series of injections and experienced significant improvement for 6 months following each series of injections. The authors point out that acetylcholine has been shown to be a mediator of itch in patients with atopic dermatitis, and they suggest that reduction in acetylcholine release mediated by botulinum toxin A may explain its helpfulness in the setting of brachioradial pruritus. They also postulate that botulinum toxin A may reduce histamine-mediated itch.

A compounded mixture of amitriptyline hydrochloride 1.0%, ketamine hydrochloride 0.5%, and Vanicream applied 2-3 times daily was reported to provide complete relief to an adult patient with a 5-year history of brachioradial pruritus unresponsive to conventional treatments.[37]

Aprepitant, a neurokinin-1 receptor inhibitor, led to symptomatic improvement in a patient with a 6-year history of bilateral brachioradial pruritus refractory to conventional treatments.[38]

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Surgical Care

Surgical care is generally not indicated unless the patient has a documented cervical radiculopathy, cervical rib, or fibrous band impinging on the brachial plexus.

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Consultations

Relief after physical therapy has been reported in case series, so consultation with a physical therapist or a chiropractor may be considered, particularly in patients with radiographic evidence of cervical spinal disease. Heyl[1] reported a case of one patient whose brachioradial pruritus developed after a neck injury, and symptoms were relieved by neck traction.

The authors have not found consultation with a neurologist or pain specialist to be of value.

Consultation with an acupuncturist may be helpful.

Some patients have psychiatric disorders that predispose to brachioradial pruritus, while others may develop anxiety, depression, obsessions/compulsions, or delusions of parasitosis in response to the exasperating symptoms.

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Diet

No dietary modifications have been reported to alleviate symptoms.

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Activity

Patients who notice exacerbation of symptoms with sunlight exposure benefit from restricting their time outdoors during peak sunlight hours (10 am to 2 pm). Often, wearing long-sleeved shirts when outdoors provides relief equal to that achieved with more sophisticated interventions. Sunscreens are typically less effective.

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Prevention

Strict photoprotection with sunscreen and long-sleeved shirts can prevent recurrence of symptoms in some patients.

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Long-Term Monitoring

Frequent outpatient follow-up of patients with brachioradial pruritus is often helpful.

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Contributor Information and Disclosures
Author

Julianne Mann, MD Assistant Professor, Department of Dermatology, Oregon Health and Science University School of Medicine

Julianne Mann, MD is a member of the following medical societies: Alpha Omega Alpha, 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, Hawaii Medical Association

Disclosure: Nothing to disclose.

Britton R Mann, DAOM, Dipl OM, LAc Private Practitioner in Acupuncture and Chinese Herbal Medicine, Metolius Natural Medicine

Britton R Mann, DAOM, Dipl OM, LAc is a member of the following medical societies: Pain Society of Oregon, Oregon Association of Acupuncture and Oriental Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

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

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .

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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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