Brachioradial Pruritus

What is brachioradial pruritus?

Brachioradial pruritus is a nerve condition that causes itching, stinging or tingling sensations in your outer forearm. It isn’t a rash or a contagious condition.

“Brachioradial” refers to the brachioradialis muscle in the lower part of your arm that helps it bend at your elbow. “Pruritus” is the medical term for itching.

Brachioradial pruritus usually affects both arms, but it can occur in only one arm.

What nerve causes brachioradial pruritus?

Irritation of your cervical nerves can lead to brachioradial pruritus. In your neck (cervical spine), you have eight pairs of spinal nerves labeled C1 to C8. These nerves supply sensation to your neck, shoulders, arms and hands. Irritation of any of the nerves between C5 and C8 can cause brachioradial pruritus.

What are the symptoms of brachioradial pruritus?

The main sign of brachioradial pruritus is itchiness on your outer forearm. The condition doesn’t involve a skin rash, but you may develop marks or skin discoloration from excessive scratching.

You may also have itching on your:

• Upper arms.
• Shoulders.
• Neck.

Some people also experience the following sensations in the affected area:

• Pain.
• Stinging.
• Tingling.

In 75% of cases, the itching and other sensations affect both arms. But it can also affect just one arm.

What causes brachioradial pruritus?

Researchers believe a combination of cervical radiculopathy and ultraviolet (UV) radiation causes brachioradial pruritus.

Cervical radiculopathy

A pinched nerve in your neck (cervical radiculopathy) can cause abnormal sensations (paresthesia) in various parts of your upper body, including your arms. You may feel tingling, numbness, pain and itching.

Several spinal issues can lead to a pinched nerve in your neck, including:

• Herniated disk.
• Osteoarthritis.
• Degenerative disk disease.
• Foraminal stenosis.

People with brachioradial pruritus often don’t realize they have a pinched nerve in their neck because they often don’t experience pain from it. However, studies show that neck imaging tests of people with brachial pruritus show evidence of spinal issues and pinched nerves.

Ultraviolet radiation exposure

Researchers aren’t exactly sure why, but they believe UV (ultraviolet) radiation is a contributing factor to brachioradial pruritus because:

• Many people report increased symptoms with sun exposure.
• Brachioradial pruritus is more common in the summer months.
• Many people report relief of symptoms during the winter months and with sun protection.

What causes brachioradial pruritus to flare up?

Sun exposure typically triggers flare-ups of brachioradial pruritus. The symptoms are often worse after being outside without sun protection.

What are the risk factors for brachioradial pruritus?

Risk factors for brachioradial pruritus include:

• Sex: Women are three times more likely to have brachioradial pruritus than men. This may be because women are more likely to have cervical spine and nerve issues due to their anatomy.
• Middle age: The average age at diagnosis is 59, but it can affect people of other ages.
• Light skin type: The condition more commonly affects people with lighter skin types.
• Outdoor lifestyle: People who develop brachioradial pruritus are typically outdoor enthusiasts, like cyclists, hikers and beach-goers. Some have an extensive history of sunburn.

How is brachioradial pruritus diagnosed?

A healthcare provider will ask you about your symptoms, medical history and lifestyle. They’ll perform a physical exam and assess your arms to be sure you don’t have a rash that’s causing the itching.

Providers can usually diagnose brachioradial pruritus with the ice pack test. Your provider will place an ice pack on the affected area. If your symptoms immediately stop and then return once your provider removes the ice pack, it usually means you have brachioradial pruritus.

In rare cases, your provider may recommend imaging tests to assess your cervical spine and spinal nerves, such as an MRI scan or X-rays.

What kind of doctor do you see for brachioradial pruritus?

In most cases, a primary care physician (PCP) can diagnose brachioradial pruritus and recommend treatment.

But they may refer you to a neurologist if your case is severe or there may be other underlying neurological issues.

How is brachioradial pruritus treated?

Treatment methods for brachioradial pruritus include:

• Avoiding ultraviolet (UV) radiation exposure.
• Oral medications.
• Topical medications.

Using ice packs on the affected area can also alleviate symptoms temporarily.

In very rare cases, healthcare providers may recommend surgery to correct cervical spine conditions.

Avoiding UV radiation exposure

Methods of avoiding UV radiation include:

• Reducing the amount of time you spend in the sun.
• Using sunscreen regularly and reapplying it as necessary.
• Wearing UV-protected long-sleeved shirts and other clothing.
• Avoiding using tanning beds.

Oral medications

Healthcare providers most commonly prescribe an oral tricyclic antidepressant called amitriptyline for brachioradial pruritus. This is because tricyclic antidepressants are known to help treat nerve issues, like neuropathic pain.

Other oral medications include:

• Gabapentin.
• Risperidone.
• Fluoxetine.
• Chlorpromazine.
• Hydroxyzine.

Topical medications

Topical medications (like creams and lotions) for brachioradial pruritus include:

• Capsaicin.
• Mild corticosteroids.
• Local anesthetics (amitriptyline/ketamine).
• Antihistamines.

Can I prevent brachioradial pruritus?

There’s no known way to prevent brachioradial pruritus. But you can reduce your risk of developing the condition by protecting your skin from exposure to sunlight and UV radiation. Wear protective clothing when you go outside. Always use sunscreen with a sun protection factor (SPF) of at least 30.

What is the prognosis (outlook) for people with brachioradial pruritus?

For many people with brachioradial pruritus, symptoms go away in a few weeks to a few months after taking medication and reducing exposure to sunlight.

For some, the itching and burning sensations come and go for the rest of their lives. In many cases, healthcare providers can successfully manage these flare-ups.

Many people with the condition find that symptoms improve during the winter months.

Some people with brachioradial pruritus experience skin complications due to excessive scratching. They include:

• Scratches and sores.
• Prurigo nodules (hard lumps).
• Lichenification (thick, leathery skin).
• Hypopigmentation or hyperpigmentation.
• Eczema.

When should I see a healthcare provider about brachioradial pruritus?

Contact your healthcare provider if you feel a constant urge to scratch your arms or experience other signs of brachioradial pruritus.

If treatment isn’t helping your symptoms, reach out to your provider for other options.

What questions should I ask my healthcare provider about brachioradial pruritus?

If you have brachioradial pruritus, you may want to ask:

• What’s causing my itchy arms?
• What type of treatment is best for me?
• What can I do to avoid complications from scratching?