Brachioradial pruritus or BRP, is a form of chronic localized neuropathic itch that affects the dorsolateral aspect of the forearms, meaning it affects the skin between your shoulder to the forearm. BRP is named after the brachioradial muscle that runs between the two joints.
BRP symptoms include tingling, burning, and itching skin on the top of one or both arms, which can extend to the shoulder and upper back. This condition usually affects middle-aged women living in warm climates, but can also affect men of all ages and people living around the world.
The exact cause of BRP is unknown, but some experts believed it could be caused by either cumulative sun damage or nerve root entrapment caused by degenerative spine diseases, or a combination of both. Chronic UV radiation can damage nerve fibers in the skin, which can make the nerves more sensitive to pain and itch sensations. It is actually believed that chronic exposure to UV radiation is what triggers the symptoms in people with cervical spine disease.
This condition is often diagnosed by a dermatologist based on the location of the symptoms and the lack of response to usual treatments for itching. Those with BRP notice that they only get relief when the use an ice pack on the affected area of the skin. This often leads dermatologists to a definitive diagnosis. Because of its high association with spine disease, the dermatologist will most likely order an x-ray of the cervical spine to rule out spine problems that may increase pressure on nerve roots to the arm. X-ray results can either show degenerative disc disease or osteoarthritis, which could further suggest BRP.
Important Note: It is imperative that you see a specialist, an allergist or a dermatologist, in case an unusual rash or possible allergy symptoms occur. Do not try any unprescribed medication.
Various therapies have been tried for BRP with mixed success rates. Topical agents that are used to improve symptoms include capsaicin cream, pramoxine cream, doxepin cream, amitriptyline, and ketamine cream. Capsaicin cream decreases the amount of a certain chemical produced in nerve endings known to cause itching and pain. Topical pramoxine works by numbing sensory nerve impulses in the skin while topical doxepin is an antihistamine cream that decreases chemicals known to cause itching. Some patients have found acupuncture effective, as well as manipulation of the cervical spine, performed by a chiropractor.
Because sun exposure is a known trigger for BRP, experts suggest those who have this condition to use sun protection on the areas where symptoms occur.