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Brachioradial Pruritus

In this article, you will find out everything you need to know about Brachioradial Pruritus and the most effective ways to treat the condition. Many of our patients have been told by their doctor or dermatologist that there is nothing else that can help other than topical creams and oral medication. This is simply not true. Here at ProHealth Clinic we help to diagnose and treat the root cause of your Brachioradial Pruritus.

We have developed a unique natural treatment approach that combines two advanced treatments: Prolotherapy and INDIBA Therapy.

Many of the symptoms associated with the condition are a result of irritation of the nerves that supply the skin in the arms. The nerves can become irritated if the surrounding structures are weak or damaged.

Prolotherapy involves the injection of a natural regenerative solution with small fine needles to strengthen and repair these surrounding structures, which then allows the nerve irritation to subside. Immediately before the injections, we use a gentle therapy device called INDIBA to both reduce inflammation in the area and enhance the absorption of the injections. The INDIBA device has been around for more than 35 years and has established a strong pedigree of research with over 300 scientific studies supporting its technology, including research from Oxford University.

As the treatment is helping to treat the root cause of Brachioradial Pruritus, many of our patients have reported permanent relief of their symptoms.

The following video testimonials are of patients of ours who had Brachioradial Pruritus and experienced life-changing results with our treatment approach:

Book your free 15-minute discovery call to find out how our tailored treatment approach can help to eliminate your symptoms. Call 01234 380345 or email info@prohealthclinic.co.uk and leave your name and number. 

Brachioradial pruritus is a nerve-related condition characterized by intense itching in the upper arms. Often linked to cervical spine abnormalities and chronic sun exposure, patients with brachioradial pruritus experience a range of symptoms from nerve pain to burning sensations. This article delves into the causes, diagnosis, and treatments of this condition, providing essential knowledge for patients and practitioners alike.

Understanding Brachioradial Pruritus

Brachioradial pruritus primarily affects the skin on the forearms, though it can extend to the shoulders and upper extremities. It is typically provoked by nerve compression within the cervical spine, leading to abnormal sensations that the brain interprets as itchiness. While the exact pathophysiology remains unclear, evidence suggests a significant correlation with cervical spine disease, including cervical degenerative disc disease and cervical radiculopathy.

Causes and Risk Factors

The onset of brachioradial pruritus is commonly associated with cervical spine abnormalities. Cervical MRI features in patients diagnosed with brachioradial pruritus often reveal morphological pathologies such as herniated discs or clinically relevant tumors pressing on the nerve roots. Chronic sun exposure is also a contributing factor, potentially damaging dermal nerve fibers. Other risk factors include having lighter skin types and being typically outdoor enthusiasts, which may lead to prolonged exposure to ultraviolet radiation, aggravating the condition.

Symptoms and Clinical Presentation of Brachioradial Pruritus

Core Symptoms of Brachioradial Pruritus

The hallmark symptom of brachioradial pruritus is an intense itching sensation primarily located on the upper arms, specifically the dorsolateral aspect, where the brachioradialis muscle is situated. Patients often describe the itch as deep-seated, sometimes accompanied by tingling or burning sensations. Unlike common itches, this type does not resolve with scratching; instead, scratching can exacerbate the affected skin, leading to secondary skin changes such as lichenification or hyperpigmentation.

Sensory Phenomena

The sensory experience in brachioradial pruritus can range from purely pruritic to a mix of pruritic and neuropathic sensations. Patients may report transient stinging, pins and needles, or even a sensation akin to that of an insect crawling on the skin, medically termed formication. This combination of symptoms suggests a neuropathic origin, where nerve fibers are involved in the pathological process.

Physical Signs of Brachioradial Pruritus

On physical examination, the affected area may show signs of excoriation due to the chronicity of scratching. In some patients, the affected skin may have little to no visible dermatologic findings, which can be misleading and result in a delayed diagnosis. Chronic refractory pruritus can lead to significant distress, with some patients developing thickened skin from persistent scratching, known as lichen simplex chronicus.

Aggravating and Alleviating Factors

Symptoms of brachioradial pruritus often worsen with exposure to heat or after periods of sun exposure, suggesting a role of ultraviolet radiation as a contributing factor. Conversely, cooling the skin, such as with ice packs or cool water, can provide significant symptomatic relief. This contrasting response to temperature changes is a distinctive feature and can be a useful diagnostic clue.

Associated Symptoms

Many patients with brachioradial pruritus also have coexisting cervical spine disease, which may present additional symptoms such as neck pain or stiffness, headaches, and other neurological symptoms related to nerve compression. These symptoms can precede, coincide with, or follow the onset of pruritus, indicating the interconnected nature of these conditions.

The Ice Pack Test

A unique aspect of brachioradial pruritus’s clinical presentation is the diagnostic ice pack test. The test involves applying an ice pack to the affected area, which typically provides immediate relief. This response can be so specific that it has been proposed as a diagnostic criterion for brachioradial pruritus.

Age and Demographic Considerations

The average age of onset for brachioradial pruritus is typically in the fifth decade of life, although it can occur in younger individuals, especially those with significant risk factors such as a history of cervical spine abnormalities or chronic sun exposure. The condition is also seen more commonly in populations residing in sunny climates, reinforcing the connection to sun-induced damage of nerve endings.

In summary, the clinical presentation of brachioradial pruritus is complex, with symptoms that reflect an underlying neuropathic condition influenced by environmental factors. The management of these symptoms requires an interdisciplinary approach, considering both the cutaneous and neurological aspects of the disease. Understanding the varied clinical features is essential for timely diagnosis and effective management of this distressing condition.

Diagnosis

To diagnose brachioradial pruritus, a thorough patient history and physical exam are conducted, focusing on neurological symptoms, neck pain, and any history of chronic pruritus. Cervical spine imaging is crucial for identifying cervical spine disease, while the examination of cutaneous innervation helps exclude other skin diseases. The diagnosis is often confirmed when traditional treatments for skin diseases fail to provide relief.

Brachioradial Pruritus Treated Strategies

Sun Protection

Due to the association with sun exposure, advising patients on sun protection is vital. This includes the use of sunscreens, wearing protective clothing, and avoiding peak ultraviolet radiation times.

Physical Therapy for Brachioradial Pruritus

For patients whose condition is linked to cervical spine disease, physical therapy, including cervical traction, can offer significant benefits. It aims to relieve nerve compression and irritation, addressing the root cause of the itch.

Oral Medications

Several oral medications have been used to treat brachioradial pruritus, such as anti-inflammatory drugs, tricyclic antidepressants, and other oral medications that alter nerve sensation. These have been met with varying degrees of success and may cause adverse events, necessitating close monitoring.

Topical Treatments

Topical medications like capsaicin cream have emerged as promising treatments. They provide a counterirritant effect, distracting the brain from the itch with a different sensation. Additionally, the regular application of ice packs can offer immediate albeit temporary relief.

Transcutaneous Electrical Nerve Stimulation

TENS has shown potential in managing neuropathic itch by sending electrical impulses to the affected nerve endings, providing an alternative pain signal and distracting from the itch.

Management of Chronic Itch in Brachioradial Pruritus Patients

For brachioradial pruritus patients, managing the chronic itch is of paramount importance. This relentless symptom not only causes discomfort but can also lead to excessive scratching, resulting in potential skin damage. The primary aim is to provide pain relief and address the cutaneous manifestations that arise from the condition. A multi-pronged approach is often required, incorporating topical treatments, systemic medications, and lifestyle changes to protect the affected areas.

Therapeutic Interventions for Neuropathic Brachioradial Pruritus

Neuropathic brachioradial pruritus, where nerve damage or pinched nerves are the underlying cause, can be particularly challenging to treat. In such cases, the focus shifts to managing neuropathic pain and the associated itch. Medications that have shown efficacy include gabapentin and pregabalin, which are used to treat neuropathic pain conditions. These can reduce the aberrant nerve signals that contribute to the chronic itch. For some patients, relief may be observed within a few weeks of initiating treatment.

Addressing Cutaneous Manifestations and Preventing Excessive Scratching

The visible cutaneous manifestations of brachioradial pruritus, such as excoriation and lichenification, are direct results of excessive scratching. To prevent further damage to the affected areas, patients are advised to keep their nails short and to use protective dressings or clothing. Behavioral techniques, such as habit reversal therapy, may also be recommended to help patients manage the compulsion to scratch.

Novel and Promising Treatment Avenues

Emerging therapies have shown promise in providing relief for brachioradial pruritus. These include promising treatment options like topical cannabinoid creams, which have anti-inflammatory and analgesic properties. Additionally, phototherapy using narrowband UVB light has been effective in some cases, particularly when the itch is exacerbated by sunlight.

Investigating the Underlying Causes: Clinically Relevant Tumors and Brachial Pruritus

In a subset of brachioradial pruritus cases, the itch may be a symptom of a clinically relevant tumor in the cervical spine region. It is crucial for clinicians to rule out this possibility through appropriate imaging studies, as the treatment will differ significantly. The presence of a tumor may require surgical intervention, which could alleviate the pressure on the nerves and provide pain relief.

Addressing Psychological Impact

It’s important to acknowledge the psychological distress that can accompany brachioradial pruritus. Supportive care, counseling, and therapy may be beneficial alongside medical treatments to provide comprehensive care for affected individuals.

Case Studies and Clinical Trials

Clinical studies often provide insights into the effectiveness of various treatments. For instance, a study involving a 57 years old make with brachioradial pruritus treated underwent chiropractic and acupuncture treatment and reported improvement in symptoms. Another research highlights that 10 out of 14 patients reported resolution of symptoms who were treat by cervical spine manipulation. Such evidence supports the cervical spine’s role in the condition and the potential of physical therapy as a treatment modality.

Frequently Asked Questions (FAQs)

What triggers brachioradial pruritus?

Brachioradial pruritus is often triggered by cervical spine abnormalities, nerve compression, chronic sun exposure, and damage to the nerve fibers in the skin.

How do you get rid of brachioradial pruritus?

Getting rid of brachioradial pruritus typically involves a combination of treatments such as physical therapy, sun protection measures, oral and topical medications, and sometimes transcutaneous electrical nerve stimulation (TENS).

How do you treat pruritus in the UK?

In the UK, pruritus is treated based on the underlying cause, which may include the use of emollients, topical steroids, antihistamines, or phototherapy, with treatment plans tailored to individual needs and supervised by healthcare professionals.

What is the treatment for itchy forearms?

Treatment for itchy forearms may include the application of moisturizers, topical anti-itch creams or ointments, cold compresses, or oral antihistamines, depending on the cause of the itchiness.

Embracing a Future Free from Itching at ProHealth Clinic

Brachioradial pruritus, a condition with a complex etiology involving nerve irritation, cervical spine disease, and sun exposure, requires a multifaceted treatment approach. Patients benefit from a combination of lifestyle modifications, physical therapy, medication, and psychological support. As research advances, a deeper understanding of cervical spine pathologies and their relationship to neuropathic pruritus will likely lead to more targeted and effective therapies, improving outcomes for those affected by this challenging condition.

Here at ProHealth Clinic, we take pride in being at the forefront of combating this condition with the most advanced approaches available. Our panel of healthcare experts is dedicated to providing personalized care that addresses not only the physical but also the emotional aspects of this condition.

We understand that each patient with brachioradial pruritus carries a unique set of challenges and, therefore, requires specialized attention. That’s why we invite you to book a consultation and benefit from expert advice tailored to your needs. Our team is ready to guide you towards an effective management plan, aiming to alleviate your symptoms and improve your quality of life.

At ProHealth Clinic, we are committed to helping you navigate your health journey with expertise, compassion, and innovative care. Don’t let brachioradial pruritus dictate your comfort and daily activities. Reach out to us, and take the first step towards reclaiming a life of ease and relief.

References

1.       Weinberg, B. D., Amans, M., Deviren, S., Berger, T., & Shah, V. (2018). Brachioradial pruritus treated with computed tomography-guided cervical nerve root block: A case series. JAAD case reports, 4(7), 640–644. https://doi.org/10.1016/j.jdcr.2018.03.025

2.       He, A., Alhariri, J. M., Sweren, R. J., Kwatra, M. M., & Kwatra, S. G. (2017). Treatment of Chronic Refractory Pruritus. BioMed research international, 2017, 4790810. https://doi.org/10.1155/2017/4790810

3.       Pereira, M. P., Lüling, H., Dieckhöfer, A., Steinke, S., Zeidler, C., & Ständer, S. (2018). Brachioradial Pruritus and Notalgia Paraesthetica: A Comparative Observational Study of Clinical Presentation and Morphological Pathologies. Acta dermato-venereologica, 98(1), 82–88. https://doi.org/10.2340/00015555-2789

4.       Alai, N. N., & Skinner, H. B. (2018). Concurrent notalgia paresthetica and brachioradial pruritus associated with cervical degenerative disc disease. Cutis, 102(3), 185–190.

5.       Vestita, M., Cerbone, L., & Calista, D. (2016). Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia, 151(6), 727–728.

6.       Kwatra, S. G., Stander, S., Bernhard, J. D., Weisshaar, E., & Yosipovitch, G. (2013). Brachioradial pruritus: a trigger for generalization of itch. Journal of the American Academy of Dermatology, 68(5), 870–873. https://doi.org/10.1016/j.jaad.2012.11.026

7.       Atış, G., & Bilir Kaya, B. (2017). Treatment of three cases with brachioradial pruritus. Dermatologic therapy, 30(2), 10.1111/dth.12459. https://doi.org/10.1111/dth.12459

8.       Strowd, R. E., Strowd, L. C., & Blakeley, J. O. (2016). Cutaneous manifestations in neuro-oncology: clinically relevant tumor and treatment associated dermatologic findings. Seminars in oncology, 43(3), 401–407. https://doi.org/10.1053/j.seminoncol.2016.02.029

9.       Salako, K. B., Anstey, A. A., & Logan, R. A. (2014). Delayed, transient, postsolar truncal pruritus: a report of two cases. Clinical and experimental dermatology, 39(6), 726–727. https://doi.org/10.1111/ced.12375

10.   Pereira, M. P., Lüling, H., Dieckhöfer, A., Steinke, S., Zeidler, C., Agelopoulos, K., & Ständer, S. (2018). Application of an 8% capsaicin patch normalizes epidermal TRPV1 expression but not the decreased intraepidermal nerve fibre density in patients with brachioradial pruritus. Journal of the European Academy of Dermatology and Venereology : JEADV, 32(9), 1535–1541. https://doi.org/10.1111/jdv.14857

11.   Wachholz, P. A., Masuda, P. Y., Pinto, A., & Martelli, A. (2017). Impact of drug therapy on brachioradial pruritus. Anais brasileiros de dermatologia, 92(2), 281–282. https://doi.org/10.1590/abd1806-4841.20175321

12.   Zeidler, C., Lüling, H., Dieckhöfer, A., Osada, N., Schedel, F., Steinke, S., Augustin, M., & Ständer, S. (2015). Capsaicin 8% cutaneous patch: a promising treatment for brachioradial pruritus? The British journal of dermatology, 172(6), 1669–1671. https://doi.org/10.1111/bjd.13501

13.   Veien, N. K., Hattel, T., Laurberg, G., & Spaun, E. (2001). Brachioradial pruritus. Journal of the American Academy of Dermatology, 44(4), 704–705. https://doi.org/10.1067/mjd.2001.112912

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