Brachioradial pruritus is a chronic condition characterized by itching or burning around the outer forearm and occasionally in the shoulder and neck region. It was first described in the literature in 1968 as solar pruritus of the elbows and brachioradial summer pruritus. It is most commonly diagnosed in middle-aged females with lighter skin tones. While the exact cause of the condition is presently unknown, it is believed to be due to either cumulative sun damage or nerve root entrapment caused by degenerative spine disease.
Research has shown that exposure to large amounts of sunlight over a short period causes a flare in symptoms. Interestingly, patients who live in colder climates report improvement in symptoms during the fall and winter months. Due to the association with spine disease, it is common for dermatologists to order an x-ray of the cervical spine to rule out spine problems that might increase pressure on nerve roots to the arm.
There are several pharmacologic and non-pharmacologic therapies that have been shown to be effective in some patients. Topical agents used to improve symptoms are capsaicin cream, pramoxine cream, doxepin cream, amitriptyline 1%/ketamine 0.5% cream, and ice packs. Capsaicin is the active ingredient in chili pepper and after the first few applications it produces a stinging sensation, but the stinging should go away and result in less itching. It works by decreasing a chemical produced in nerve endings known to cause itching and pain. Topical pramoxine is an anesthetic cream that works by numbing sensory nerve impulses in the skin. Topical doxepin is an antihistamine cream that decreases chemicals that are known to cause itching. The most successful topical agent, according to research thus far, has been amitriptyline 1%/ketamine 0.5% cream used 2-3 times daily. Interestingly, ice may offer good relief for patients. It works so well to alleviate the itch in patients with brachioradial pruritus that it has become known as the “ice-pack sign,” which helps make the diagnosis.
Oral medications used to alleviate the symptoms include gabapentin, lamotrigine, carbamazepine, valproate, and oral antihistamines. Treatments in addition to pharmacotherapy include physical therapy for the spine, cervical traction devices, acupuncture, and osteopathic manipulative therapy. In addition to the medical treatments mentioned, it is crucial for patients to have good sun protection in the areas where symptoms occur.
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