Brachioradial Pruritus Treatment & Management
- Author: Julianne Mann, MD; Chief Editor: Dirk M Elston, MD more...
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, 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.
Acupuncture may be helpful for symptomatic relief. Stellon 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. 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.
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.
Surgical care is generally not indicated unless the patient has a documented cervical radiculopathy, cervical rib, or fibrous band impinging on the brachial plexus.
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 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.
No dietary modifications have been reported to alleviate symptoms.
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.
Strict photoprotection with sunscreen and long-sleeved shirts can prevent recurrence of symptoms in some patients.
Frequent outpatient follow-up of patients with brachioradial pruritus is often helpful.
Heyl T. Brachioradial pruritus. Arch Dermatol. 1983 Feb. 119(2):115-6. [Medline].
Veien NK, Hattel T, Laurberg G, Spaun E. Brachioradial pruritus. J Am Acad Dermatol. 2001 Apr. 44(4):704-5. [Medline].
Bernhard JD, Bordeaux JS. Medical pearl: the ice-pack sign in brachioradial pruritus. J Am Acad Dermatol. 2005 Jun. 52(6):1073. [Medline].
Waisman M. Solar pruritus of the elbows (brachioradial summer pruritus). Arch Dermatol. 1968 Nov. 98(5):481-5. [Medline].
Walcyk PJ, Elpern DJ. Brachioradial pruritus: a tropical dermopathy. Br J Dermatol. 1986 Aug. 115(2):177-80. [Medline].
Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease: Neurocutaneous dysesthesias. J Am Acad Dermatol. 2016 Feb. 74 (2):215-28; quiz 229-30. [Medline].
Massey EW, Massey JM. Forearm neuropathy and pruritus. South Med J. 1986 Oct. 79(10):1259-60. [Medline].
Crevits L. Brachioradial pruritus--a peculiar neuropathic disorder. Clin Neurol Neurosurg. 2006 Dec. 108(8):803-5. [Medline].
Fisher DA. Brachioradial pruritus wanted: a sure cause (and cure) for brachioradial pruritus. Int J Dermatol. 1997 Nov. 36(11):817-8. [Medline].
Binder A, Folster-Holst R, Sahan G. et al. A case of neuropathic brachioradial pruritus caused by cervical disc herniation. Nat Clin Pract Neurol. June 2008. 4 (6):338-342. [Medline]. [Full Text].
Wallengren J, Sundler F. Brachioradial pruritus is associated with a reduction in cutaneous innervation that normalizes during the symptom-free remissions. J Am Acad Dermatol. 2005 Jan. 52(1):142-5. [Medline].
Wallengren J. Self-healing photo-neuropathy and cervical spinal arthrosis in four sisters with brachioradial pruritus. J Brachial Plex Peripher Nerve Inj. November 2009. 17; 4:21. [Medline]. [Full Text].
De Ridder D, Hans G, Pals P, Menovsky T. A C-fiber-mediated neuropathic brachioradial pruritus. J Neurosurg. October 2009. 1-4. [Medline]. [Full Text].
Wallengren J, Dahlbäck K. Familial brachioradial pruritus. Br J Dermatol. 2005 Nov. 153(5):1016-8. [Medline].
Bech-Thomsen N, Thomsen K. Solar pruritus. Acta Derm Venereol. 1995 Nov. 75(6):488-9. [Medline].
Kestenbaum T, Kalivas J. Solar pruritus. Arch Dermatol. 1979 Nov. 115(11):1368. [Medline].
Orton DI, Wakelin SH, George SA. Brachioradial photopruritus--a rare chronic photodermatosis in Europe. Br J Dermatol. 1996 Sep. 135(3):486-7. [Medline].
Armstrong DK, Bingham EA. Brachioradial pruritus--an uncommon photodermatosis presenting in a temperate climate. Dermatology. 1997. 195(4):414-5. [Medline].
Masuda PY, Martelli AC, Wachholz PA, Akumatsu HT, Martins AL, Silva NM. Brachioradial pruritus -- descriptive analysis of Brazilian case series. J Dtsch Dermatol Ges. 2013 Jun. 11(6):530-5. [Medline].
Zabludovska K, Anderson MD, Jemec GB. Photoallergic reactions to varenicline mimicking brachioradial pruritus. J Am Acad Dermatol. 2013 Sep. 69(3):484. [Medline].
Barry R, Rogers S. Brachioradial pruritus--an enigmatic entity. Clin Exp Dermatol. 2004 Nov. 29(6):637-8. [Medline].
Goodkin R, Wingard E, Bernhard JD. Brachioradial pruritus: cervical spine disease and neurogenic/neuropathic [corrected] pruritus. J Am Acad Dermatol. 2003 Apr. 48(4):521-4. [Medline].
Marziniak M, Phan NQ, Raap U, Siepmann D, Schürmeyer-Horst F, Pogatzki-Zahn E, et al. Brachioradial pruritus as a result of cervical spine pathology: the results of a magnetic resonance tomography study. J Am Acad Dermatol. 2011 Oct. 65(4):756-62. [Medline].
Tait CP, Grigg E, Quirk CJ. Brachioradial pruritus and cervical spine manipulation. Australas J Dermatol. 1998 Aug. 39(3):168-70. [Medline].
Kavak A, Dosoglu M. Can a spinal cord tumor cause brachioradial pruritus?. J Am Acad Dermatol. 2002 Mar. 46(3):437-40. [Medline].
Rongioletti F. Pruritus as presenting sign of cervical rib. Lancet. 1992 Jan 4. 339(8784):55. [Medline].
Lane JE, McKenzie JT, Spiegel J. Brachioradial pruritus: a case report and review of the literature. Cutis. January 2008. 81(1):37-40. [Medline].
Cohen AD, Masalha R, Medvedovsky E, Vardy DA. Brachioradial pruritus: a symptom of neuropathy. J Am Acad Dermatol. 2003 Jun. 48(6):825-8. [Medline].
Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine. 1986 Jul-Aug. 11(6):521-4. [Medline].
Savk E, Savk SO. On brachioradial pruritus and notalgia paresthetica. J Am Acad Dermatol. 2004 May. 50(5):800-1. [Medline].
Mirzoyev SA, Davis MD. Brachioradial pruritus: Mayo Clinic experience over the past decade. Br J Dermatol. 2013 Nov. 169(5):1007-15. [Medline].
Kanitakis J. Brachioradial pruritus: report of a new case responding to gabapentin. Eur J Dermatol. 2006 May-Jun. 16(3):311-2. [Medline].
Kwatra SG, Stander S, Bernhard JD, Weisshaar E, Yosipovitch G. Brachioradial pruritus: a trigger for generalization of itch. J Am Acad Dermatol. 2013 May. 68(5):870-3. [Medline].
Wallengren J, Sundler F. Cutaneous field stimulation in the treatment of severe itch. Arch Dermatol. 2001 Oct. 137(10):1323-5. [Medline].
Stellon A. Neurogenic pruritus: an unrecognised problem? A retrospective case series of treatment by acupuncture. Acupunct Med. 2002 Dec. 20(4):186-90. [Medline].
Kavanagh GM, Tidman MJ. Botulinum A toxin and brachioradial pruritus. Br J Dermatol. 2012 May. 166(5):1147. [Medline].
Poterucha TJ, Murphy SL, Davis MD, Sandroni P, Rho RH, Warndahl RA, et al. Topical amitriptyline-ketamine for the treatment of brachioradial pruritus. JAMA Dermatol. 2013 Feb. 149(2):148-50. [Medline].
Ally MS, Gamba CS, Peng DH, Tang JY. The use of aprepitant in brachioradial pruritus. JAMA Dermatol. 2013 May. 149(5):627-8. [Medline].
Bernstein JE. Capsaicin and substance P. Clin Dermatol. 1991 Oct-Dec. 9(4):497-503. [Medline].
Goodless DR, Eaglstein WH. Brachioradial pruritus: treatment with topical capsaicin. J Am Acad Dermatol. 1993 Nov. 29(5 Pt 1):783-4. [Medline].
Knight TE, Hayashi T. Solar (brachioradial) pruritus--response to capsaicin cream. Int J Dermatol. 1994 Mar. 33(3):206-9. [Medline].
Zeidler C, Lüling H, Dieckhöfer A, Osada N, Schedel F, Steinke S, et al. Capsaicin 8% cutaneous patch: a promising treatment for brachioradial pruritus?. Br J Dermatol. 2015 Jun. 172 (6):1669-71. [Medline].