What is Brachioradial Pruritus?

Brachioradial pruritus (BRP) is a skin condition that causes intense itching and can lead to the development of neurodermatitis. The emergence of brachioradial pruritus cases in temperate climates has further contributed to research efforts to discover more about the epidemiology of this neurocutaneous condition. Affecting one's upper extremities, treatment for brachioradial pruritus is centered on symptom management and may be multifaceted in approach, including the use of medications to alleviate discomfort.

Historically considered to be found only in tropical regions, brachioradial pruritus has become more common in temperate areas, such as the United States. Named for the forearm muscle commonly affected, known as brachioradialis, this neuropathic presentation primarily affects the upper body, specifically, the arms and shoulders. It is not uncommon for individuals to demonstrate symptoms on either one or both sides at the same time.

There are two competing hypotheses regarding the origin of brachioradial pruritus symptoms. One argues that nerve damage within the cervical spine contributes to pruritus symptom development. The other hypothesis suggests that prolonged, excessive sun exposure induces nerve damage causing a disruption in nerve function. Both hypotheses tend to agree that pruritus symptoms originate with a physiological disruption and impairment of nerve function.

A diagnosis of brachioradial pruritus is generally made once other conditions have been ruled out. Usually a blood panel may be ordered to check for signs of anemia or other markers indicative of deficiency, disease or infection. Additional laboratory testing, such as cultures and skin biopsy, may be performed to rule out other skin conditions, including psoriasis and dermatitis, and check for signs of atrophy or other forms of dermal damage.

Individuals with brachioradial pruritus often experience irritation and dryness in the affected area. Though most pruritus episodes may occur without any visible signs, some individuals can develop blisters or bumps in the area that itches. Individuals with this condition often develop excessively dry skin in pruritus-affected areas that easily cracks and bleeds, causing intense discomfort. According to some academic and medical organizations, including the Department of Dermatology at Oregon Health and Science University, evidentiary symptoms, including leathery-textured skin and, in some cases, patterned nerve damage often associated with prolonged sun exposure, do support the sun exposure hypothesis. Intense, aggressive scratching can also contribute to complications, including bacterial infection, altered pigmentation and scarring.

Treatment for brachioradial pruritus is usually multifaceted, focused on symptom management and can promote disease remission. Individuals may find relief with cold compresses or ice packs on the affected area. Topical corticosteroidal medications may be used to alleviate irritation and inflammation. Available, experimental treatments, such as the use of nerve blocks, should be discussed with a health care provider to determine what is best for the individual. Alternative treatment forms, including acupuncture, may also be used for temporary symptom relief.