What are the other Names for this Condition? (Also known as/Synonyms)

• BRP (Brachioradial Pruritus)

What is Brachioradial Pruritus? (Definition/Background Information)

• Brachioradial Pruritus (BRP) is a severe itchy condition of unknown cause that is localized to the forearms. The condition is not associated with any skin lesions; however, intense scratching can result in bleeding and rashes
• The condition is mostly observed in middle-aged Caucasian women and is sometimes associated with sports, such as tennis and golf, and water sports such as sailing. Hot sunny weather is believed to aggravate Brachioradial Pruritus. Some cases are reportedly associated with cervical spine abnormalities
• A management of Brachioradial Pruritus typically involves mitigating the signs and symptoms through topical medications and use of ice-packs for itching relief. However, the prognosis of the condition is not predictable since there is no effective treatment, and the itching is also known to recur intermittently

Who gets Brachioradial Pruritus? (Age and Sex Distribution)

• Brachioradial Pruritus may be observed in individuals of a wide age range, although a greater number of cases are seen in middle-age
• Both males and females are affected; but, more women than men are affected
• Worldwide, there is no racial or ethnic preference observed. However, the condition is mostly observed in fair-skinned individuals

What are the Risk Factors for Brachioradial Pruritus? (Predisposing Factors)

The risk factors for Brachioradial Pruritus may include:

• Caucasians, since many cases are noted among them
• Sun exposure may be a risk factor, or it may aggravate the condition
• An association of the condition with outdoor sport activities, such as lawn tennis, golf, and sailing, is noted. It is reported that any outdoor activity in sunny weather may heighten the risk
• Some medical literature informs that Brachioradial Pruritus is associated with spinal abnormalities such as cervical radiculopathy, cervical disc herniation, and very rarely, cancer to the region
• Mandibular pathology, such as an abscessed tooth, can lead to Brachioradial Pruritus

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Brachioradial Pruritus? (Etiology)

The exact cause of development of Brachioradial Pruritus is not well-understood. Experts have proposed the following mechanisms that are not proven yet:

• Long-term exposure to direct sunlight that leads to skin damage from ultraviolet radiation; hence, it is generally reported among fair-skinned individuals
• Abnormalities of the cervical spine leading to neurological symptoms such as itching (pruritus)

What are the Signs and Symptoms of Brachioradial Pruritus?

The signs and symptoms of Brachioradial Pruritus may include:

• Severe itching sensation (pruritus) in the absence of a skin rash
• In most cases, the itch is noted on the forearm; the skin above the brachioradial muscle is involved
• The itching is usually focal, meaning it is confined to the particular region
• One or both arms may present itching
• The itching may extend up the arm to the neck and shoulder, or even to the trunk region
• Placing an ice pack over the itching area is known to decrease the symptoms
• Chronic overuse of ice can lead to changes in the itch/pain nerves, making the pruritus worse
• Intense itching can result in scratch marks, bruises, bleeding from the scratch wounds, thickening of skin, and formation of firm lumps (prurigo nodularis)

In some cases, the itching may be accompanied by stinging and burning sensation, decreased sweating, and abnormal skin reaction to heat or cold.

How is Brachioradial Pruritus Diagnosed?

A diagnosis of Brachioradial Pruritus may involve the following exams and procedures:

• Physical examination of the individual and medical history evaluation
• Neurological examination, if required
• Dermoscopy: Dermoscopy is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Imaging studies, such as CT or MRI scans of the cervical spine region, may be necessary in patients with neurological presentations
• Skin biopsy is generally not helpful

A differential diagnosis is important to exclude diseases/conditions that present similar signs and symptoms. These may include:

• Compulsive skin picking
• Dermatitis artefacta
• Dry skin

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Brachioradial Pruritus?

The possible complications due to Brachioradial Pruritus include:

• Emotional stress and depression due to intense itching
• Loss of sleep due to night-time itching
• Superimposed bacterial and fungal skin infections
• Complications from the underlying spinal cord abnormality, if any present
• Recurrence of the condition
• Treatment complications

How is Brachioradial Pruritus Treated?

It may be difficult to treat Brachioradial Pruritus since the cause is not well unknown, and the condition is known to recur. However, the condition may be managed symptomatically via the following measures:

• Using ice packs for relief from severe itchiness
• Use of topical creams such as lidocaine, or menthol
• Capsaicin (extracted from pepper) cream used long term can help decrease itching. It is not to be used on broken skin, as it would be painful
• Acupuncture therapy
• Medications for depression may be prescribed
• Managing suspected cause may involve:
  • Undertaking neurological evaluation and adequate treatment of any cervical spine anomalies
  • Spending less time in the sun; application of topical sun protection creams and use of wide-brimmed hats

How can Brachioradial Pruritus be Prevented?

Currently, it is not possible to prevent Brachioradial Pruritus since the cause of the condition is unknown.

What is the Prognosis of Brachioradial Pruritus? (Outcomes/Resolutions)

• The prognosis of Brachioradial Pruritus is hard to predict since there are no established causes and well-defined treatments for the condition
• Also, the intense itchiness is known to recur; and, prolonged or repeated treatments to reduce symptoms may be necessary

Additional and Relevant Useful Information for Brachioradial Pruritus:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/