Laboratory Studies

If herpes zoster is suspected, consider direct immunofluorescence with fluorescein-tagged antibody or polymerase chain reaction studies to detect varicella-zoster virus.

Imaging Studies

Among patients who do not respond to conventional treatments or whose symptoms progressively worsen despite treatment, consider cervical spine MRI to rule out tumor or cervical rib and to evaluate for cervical radiculopathy.^[32] In those with spinal cord injury, brachioradial pruritus may point to underlying syrinx formation.^[35]

Procedures

Electromyography or nerve conduction velocity studies may show delay of F responses of median and ulnar nerves and may assist in diagnosis in ambiguous cases.^[8]

Histologic Findings

Biopsy of skin reveals atrophy and signs of sun damage, along with reduced numbers of both dermal and epidermal nerve fibers. Evidence exists that this reduction in cutaneous innervation occurs only during symptomatic flares, with innervation normalizing during symptom-free periods; thus, biopsy should ideally be performed when patients are actively experiencing symptoms.^[12]

Staging

No staging system currently exists for brachioradial pruritus.

Treatment & Management

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Media Gallery

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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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, Dip OM, LAc Private Practitioner in Acupuncture and Chinese Herbal Medicine, Metolius Natural Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, 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; .

Brachioradial Pruritus Workup

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

References

Tables

Contributor Information and Disclosures

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