Brachioradial pruritus

Brachioradial pruritus is a condition where itch, burning and/or changed sensation arise in the areas of skin on either or both arms. The most commonly affected area is the mid-arm.

The affected skin may appear entirely normal. Visible changes may arise from rubbing and scratching the affected area. These include purpura and ecchymoses (bruises), hyperpigmentation (brown marks), hypopigmentation (white marks), lichen simplex (a type of eczema) and scarring. There may be changed sensation when this is tested for with pinprick, cotton wool or heat and cold.

Cause of brachioradial pruritus

Brachioradial pruritus is due to nerve damage. It is more often reported in sunny climates such as New Zealand and Australia, than in cooler areas such as the United Kingdom. It has been suggested that long term sun exposure is responsible, as the outer aspects of the arms are most often affected and these are exposed to more sun than the inner aspects of the arms.

However, in many cases, the nerve damage arises in the cervical spine (neck), when it may be due to:

• Cervical vertebral osteoarthritis
• Cervical rib
• Cervical spinal tumour
• Nerve compression by another structure

Treatment of brachioradial pruritus

Treatment is not always successful. Effective measures include the following:

• Sun protection wearing clothing with long sleeves (more effective than sunscreens alone).
• Cooling lotions as required (camphor and menthol).
• Cervical spine manipulation. This must be done by an appropriately qualified health professional.
• Electrical cutaneous nerve field stimulation.
• Capsaicin cream – this depletes nerve endings of their chemical transmitters.
• Local anaesthetic creams.
• Amitriptyline tablets at night.
• Anticonvulsant agents including gabapentin.