Brachioradial Pruritis: Scratching Makes the Itching Worse
A 45 year old woman presented to my office complaining of a burning itching rash on both her arms.She had seen several doctors and tried various creams and oral antihistamines without relief. Only applying an ice pack seems to alleviate her symptoms. She is frustrated. On exam she had a few subtle excoriations (scratches) on her forearms, but no other signs of rash or disease.
Brachioradial pruritis is a condition characterized by intractable itching on the top of the forearms (overlying the brachioradialis muscle). Patients often report that the itching actually gets worse with scratching instead of better. It affects mostly middle aged women (which all my patients have been) and presents as a burning and itching sensation on the arms. The symptoms can sometimes be described as tingling or even painful. It can involve one or both arms.
Unfortunately the cause is not well understood. Current thinking is that it is associated with sun damage and/or with cervical nerve root impingement. The sun damage theory is that deep penetrating ultraviolet light (UVA) damages fine pain nerve fibers in the skin of the arms. The cervical spine theory is that impingement (pinching) of the C5 to C8 cervical nerve roots leads to nerve damage. The nerves that emerge from these roots provide sensation to the arms, so damage to them might cause the burning and itching symptoms. Although studies have found that cervical spine disease is more common in patients with brachioradial pruritis, no study has demonstrated that cervical spine disease causes the condition.
Treatments for brachioradial pruritis include:
- Avoidance of sun exposure (probably most important)
- Topical capsaicin (hot pepper oil)
- Gabapentin
- Cervical spine manipulation
- Anti-inflammatory medications such as naproxen (Alleve®)
- Above all, I think it is helpful just to have a physician who understands that the patient’s symptoms are real and who is willing to try various treatments until a satisfactory remedy is found.
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Something I have never heard of…sounds like a bad one to me.
I just came across this term in an article in the New Yorker on itching. I believe I have this condition - a spot on my right forearm that itches, with no apparent dermatological genesis. When I asked my dermatologist about it, she examined it under magnification, and asked if I had problems with my neck - which I do (degenerative disc disease). I am a 53 year old male. The problem has been going on for a few years. It is not severe, more of an annoyance than anything, and no treatment has been attempted. I will have to watch to see if sun exposure is a factor. One odd thing is that the affected area (approx 2cm x 4cm) has more dense hair growth than the rest of my forearm.
I have had BRP for 14 years. At first it was only alittle itching on my forearm. Now it’s a 24/7 thing, and very bad. The only thing that works is ice. It almost makes me home bound.I do things around the house with ice packs tied to my arms. I can not work. So I have no health insurance to go to the doctor. Anyway I have been to many with no help at all. I would cut my arm off but I know it would be back on the other arm Ha Ha .It is worse at night. I sleep with Ice packs in my pillow case, and always one in arms reach. I put no cover on the icepack. The burn of it feels great.But when they warm up I wake up itching. I have little blood spots all over the sheets.My life sucks because of it. Darlene
AAAAAHHHHHH GGGGGGRRRRRRRRRRRRR the itching sucks I would love to cut my arm off… or just dig the area out with a knife…. I get to the point that ice isn’t working as good as it use to …. can’t sleep… would love to sleep…. going to the store again tomorrow and going to try to find som capsaicin and see if that works.. it is rediculous that no doctor has found a cure for it… I know it has been around a while… my mother said she use to have it and still does but not as bad so 30 yrs ago people had it…
I just went to a dermatoligist today about the same problem and was told that I probably Brachioradial Pruritis. I’m a little nervous about the probably part, beacuse this is really awful. I have had this problem for about a year now and it is so frustrating and it is getting worse. My upper arms on the outside and also around my right shoulder blade is affected by the itching. My skin feels like there are tiny needles sticking me, or that I am being stung over and over. When I scratch, the itching and sting is worse! My skin does feel rough in areas and rash like, but I was told that this is probaly from the scratching. I left with a prescription for lubriderm 240 litex 60 methal 48 and also zyrtec at night. Could this be serious? I know that it is seriously irratating!:(
OK - I’ve read all the articles I can find on this annoying itching on my arms so I tried the Capsazin and now my arm burns so bad that I think that’s worse than the itch. Maybe because I was up half the night itching it last night and the skin is irritated. I take anti-anxiety meds and anti-depressants as my husband is terminally ill and I’m his caregiver. I don’t know of a way to reduce the stress in my life due to the situation I’m in. His disease is one that will go on for many years and I don’t think I can take this itching another day. I’ve been to two dermatologists who didn’t know what it could be. Everything they gave me for itching didn’t work because it’s under the skin not on top. Plus I’ve been to an allergist and nothing they gave me helped either. Has anyone had the burning issue with Capsazin?
I have this condition for 14 years, with no real relief. I can’t believe how many others are suffering with this. My sister has it, and my mom had it. I went to one dermatologist years ago who insisted it was dry skin, and just didn’t listen to me. Yes- I have taken a steak knife to my arms at times. Ice packs only provide a temporary fix. It is hard to make people understand exactly what I’m feeling and how really awful it is. Any other suggestions out there?
I think I have this condition and so does my brother. From what I’ve already read, it appears this is possibly hereditary as well. The itching I have is definitely intensified by scratching. The relief only lasts a few seconds. It almost feels like the hair follicles are stinging or that individual hairs on my arms are being pulled. I too,have no visible rash and I itch from the back of my hand to three quarters up my arm. I only have a few marks from where I have broken the skin from scratching. I have discovered something that gives me relief. Aloe Gel with Lidocaine (found near tanning products) and Solar Caine Spray. I think anything with a cooling effect and Lidocaine might work Good Luck!
I too have that terrible itch.I am 54 years old & from New Jersey. It started about 6 years ago. It usually starts in the summer, this year it was earlier because I find that when I went out into the sun, I did have sun screen on but I am very fair and sometimes get burned using the best sunscreen. Once I get the first sunburn I notice the itching starts. It does feel like pins under the skin & everything else that everyone has described.I thought that I was the only one going through this problem, it’s nice to know that there are others out there & I am not crazy. I went to my regular doctor & he prescribed Fluticasone Propionate Cream. I was only allowed to put it on twice a day, once in the morning & then at night before bed. For me it worked & eventually it went away until the next year. Ask your Doctor to prescribe it & try it, it’s worth a try for relief. Good Luck!!!
i have this same symptom mine started about 4 years ago after a neck surgery i also been to dermatologist the last one here in florida sent me to a doctor who specializes in allergies he also came up with i have brachioradial pruritis i itch so bad i bleed in direct sunlight or room temperature above 70 degrees is worse i have to keep my house around 64 degrees to sleep iwas told to use capsazin its a pepper type cream it just heated things up worse like i had a bad sunburn made it 3 times worse only thing i found that gives me relief is before work every morning i put on a heavy coat of eucerin calming creme and before bed with a/c on 64 degrees.
I too have this problem and thought it was aggravated by Splenda or fake sugar like in pop…I “had” started to eat more of the Splenda and was using diet pop so this is the only thing that seemed to be new to my diet……some times i get a sore muscle when this happens not sure if it’s the stress of the hitching that gets the muscel sore…any body else have that kind of reaction????
??? have any of you folk that have this or people reading this had Bell’s Palsy whidch I had for 18 months or suffer a tram of some kind…these are some things I also have had happen and wondered if any one else has that migh triggered the itch .?????…..
I am a 51 year old man in California and I was diagnosed with BRP recently after having symptoms for over a year. I have some cervical spine degeneration and have noticed that when I have the itching my neck hurts worse. However I have also noticed a correlation with sun exposure. I have tried all kinds of creams but have had good results calming the itching with Lanacaine, which is available over the counter.
has anyone tried acupuncture for brachiradial pruritis? i live in north county (san diego)…referrals would be greatly appreciated.
I too have the same symptoms. I am 52 and it started about 4 years ago. I thought it was something to do with the menopause but I’m now sure it’s BRP. I have lived in southern Spain for 6 years and I’m sure it’s sun exposure that is to blame. Mine gets terribly bad at night and my skin feels as though it’s raw with needles trying to get out and creepy crawlies all over. My left arm is far worse than my right. It drives me crazy! Fenistil antihistamine gel helps a little. Cannot wait for the winter when it seems to get a lot better.
I had a very bad night last night, I was up 3 hours scratching & going out of my mind. I was besides myself. People that have never experienced BRP can never imagine what we are going through.I called the dr. who gave me a prescription for Cetrizine known as Zyrtec & also gave me a cream Desoximetasone whick I noticed you can buy on-line, just google it & it can be purchased.It is about 49.00. It is worth every penny if it works. I will let everyone know if it helps. It always amazes me that the itching is uncontrollable at night time. I am fine during the day but when night comes it is all over. Again, I know that my first sunburn triggered it so that is where I got it from year to year. No one else in my family has it either. I will write again tommorrow night to let you all know if it helped.
After taking the medication that I posted in my previous letter yesterday, I finally had a good night sleep. Zyrtec can be bought over the counter for the itching, I am glad I tried it. It did give me the relief that I was looking for. I took it about an hour before I went to sleep & had a restful sleep, Thank God!!
I had no idea what was happening with this insane itch, just and only in the crook of my left elbow -this was almost 20 years ago! One of my clients [I am a psychotherapist and was doing group therapy at the time] offered me an ointment “Triancinolone” and brought me some [yes I know it's illegal!] which seemed to really help. However, it got worse over the years. But here’s the scene: I lived in the CA Central Valley [very sunny !]and still do. However, I have had significant trauma to my head, neck, and spine - I feel no pain now, but I am 68 years old, and still active in the gym, etc. I have been in near fatal car wrecks [early in my life] and I must admit fights [where anything can happen to your body] as well as just passing out and hitting the floor, sometimes with my head hitting first [though oddly enough, I never suffered any more that one drop of blood or one 'lump'from any of these several experiences]. So I conclude that trauma to my own c5 - c8 vertabrae could be the cause, PLUS the extreme UV here in the Central Valley, Tulare/Fresno/Kings/Madera/Kern counties of CA. I can say this, that ICE HELPS: I got onto that by three rotator cuff surgeries, caused by trauma incurred by me. I have taken the gabotpentin and the Lyrica which help some. Heroin or morphine would probably help more; also alcohol. Self hypnosis helps some, but then I also have ‘restless leg syndrome’ and have Rx for that. I am a licensed LCSW, by the way, and I had only suffered from this diabolical itch; having no dx or possible etiologies for it. Thanks so much for litening/reading! -gare
I started having the uncontrollable itching several months ago on the top of my arms around from the elbows. it seems to switch around from arm to arm, so far it has not been on both arms at the same time.it started during the end of the day the first time i noticed it. at first i thought it was from some auto body work, i have been resoring an old car, but then it seemed to be related to nerves,personal worries, (KIDS,THINGS AT WORK etc… i have had some problems with my neck for several years,feels like a muscle strain radiating down my right shoulder. back to the iching, it is very bad at night i wake up digging with my nails, hard enough that it should be bleeding. i’ve tried alcohol, very hot water, i found a lighter one night and heated it up stuck it to my arm, but it didnt help. i just found that ice helps a few nights ago. im am a 39 year old man.
Hello fellow BRP sufferers ! I want to pass along to all of you what has been my saving grace when it comes to this intense itching of the forearms. Until I payed a visit to my dermatologist I thought I had come in contact with an allergen of some kind. Then it got to the point that only ice packs would relieve the itch. He prescribed “ZONALON” 5% …. this cream does the job for me! I apply in morn and eve, and can re-apply during the day if the itch bothers me . Most days it is just 2x per day. It also comes in an oral pill form. Pricey but worth every penny for the relief !! Check it out….
i’ve read carolyns blog from sept. 17th, i have been using splenda and drinking diet drinks for several years and never had any problem with this until several months ago.i also have been exposed to the sun (uv rays) all of my life.i spent a lot of time this summer in the sun at the river, and i ride a motor cycle with my arms exposed as well.
Well I have found it somewhat comforting to see that I am not the only one with this itch but I am not happy about the lack of treatment available.
I have woken up in the middle of the night scratching to the point of bleeding. I have also laid in bed thinking of which would be worse, the itch or taking a knife and slicing the skin off my arms. I’m going to talk to my doctor about the Zonalon cream. But since the itch is only at night, I really believe that it is nerve related.
Thank heavens for this website. I thought I was losing my mind for the past 10 years. I had neck surgery but to no avail. I am glad to hear of the cream Zonalon 5%. I’ll give anything a try. Maybe someday something else can be done medically.
I am 41 and have had the same horrible feeling on my arms. I have gone to so many doctors and never have been told I have BRP. I just found this site and just diagnoised myself. Yes Ice does work sometimes, I also have tried all creams and the only ones I think that works is the medicated like Gold Bond. It makes your arm feel cold, I also have been presc. Zonalone Cream (expensive) does work. I was going to try an oral med for fungal infection, since it does get worse from sun exposure. I also have had back surgery and this did start a year after and now I have problems with my neck. I have gone to doctors and even friends down understand what it feels like. I have now sat here typing and got the itching under control because my hands where to busy typing, I wasn’t scratching. Well gonna go get somethings done before it starts again. Hope everyone finds some kind of relief.
In the past 4 yrs I have had 4 outbreaks - absolutely random - just crazy. Went to a doctor and they thought I had shingles. Went to a dermatologist and she thought it was BRP. I googled it and here I am - what a relief to hear others have exactly what I have been dealing with. My symptoms start as a hornet stinging sensation that radiates out to a burn triggering a crazy desire to scratch/dig it out. As I said to my doctors I wish I could have dug out my forearms. I have had 3 outbreaks on my right forearm and one on my left. I have found that by using ice to the point where I get my arm numb really helps. My last outbreak was the worst about 2 weeks ago - went on from 11:30 pm - 3:00 am - back and forth every 5 minutes sting, burn, scratch, ice and so on. Some words of wisdom for you out there. Unfortunately, I sratched it so hard I developed a staff infection - the sore is about 3 cm x 5 cm. The doctor said our fingernails aren’t the cleanest and if you scratch that hard to break open some of the skin it can lead to infection - just great. So be careful on the scratching! Thank you all for your advice on treatments - helps alot!!!
I wrote to this site last month. Today the itch was so bad on my left arm I applied ice until my arm was so numb I could barely use my left hand. When I stopped icing it, guess what? The itch was still there. Afew weeks ago, I actually scratched my arm up with a straight pin until I bled, then rubbed jalapeno into it. It burned a little, but the itch was relieved. I had scoliosis surgery in my 20’s, I am now 46 and have neck/shoulder pain and tightness alot of the times. There must be a correlation, especially after reading all your letters. My sister who also suffers, recently found out she has a cervical rib, which I think is an extra little bone at the top of her ribcage. Mine does not seem to be seasonal, just pops up whenever. I grew up on LI, but moved to NC last year. Didn’t make any difference. I will try some of the things I have read in all your letters. I wonder if this is how a dog with hot spots feels…