Brachioradial Pruritus - Causes, Clinical Features, Diagnosis, and Treatment

Introduction:

The primary function of all the muscles in our body is to aid in various movements—similarly, the brachioradialis muscle helps flex the forearms. A condition known as brachioradial pruritus causes a tingling sensation over the brachioradialis muscle area on the upper limbs, which may lead to other skin damage on scratching. Women with fair skin tone and between 45 to 60 years of age are more likely to get it than men. This article illustrates the causes, diagnosis, and treatment of brachioradial pruritus.

What Is Brachioradial Pruritus?

Brachioradial pruritus refers to the nerve-related itching or burning sensation on the forearm. Both forearms are affected but may occur on one side in rare cases. It is a localized condition, but scratching may cause it to spread to the neck, shoulder, lower legs, etc.

What Causes Brachioradial Pruritus?

The most common cause of brachioradial pruritus are listed down:

• Ultraviolet (UV) Exposure - The brachioradial pruritus is highly predisposed to the summer season. The C-type of nerve fibers is responsible for transmitting the itch sensation. Increased exposure to ultraviolet radiation destroys and reduces the number of C-fibers in the skin. However, it decreases in the winter season and with sun protection.

• Spinal Abnormalities - Several spinal conditions like degenerative disc disease (the wearing of spinal discs), disc herniation (bulged discs that are present between vertebrae), osteoarthritis (joint disease), etc., exert pressure on the adjacent nerve. The compression of the nerve supplying the forearm may lead to pruritus.

What Are the Features of Brachioradial Pruritus?

The affected site is usually the outer part of the forearm, and it may extend to the shoulders, neck, and upper arms. The characteristic features of pruritus occur 75 % in both arms, and it includes:

• Pain.

• An itching or tingling sensation occurs over the affected area.

• Urge to scratch the forearms.

• Lichenification (thickening and hyperpigmentation of skin) and lumps may occur due to severe scratching.

• Excoriation or skin picking may be observed.

It more commonly occurs in individuals with extensive sunburn (bikers and those involved in outdoor activities).

How Is Brachioradial Pruritus Diagnosed?

• Physical Examination: The doctor examines the skin and may enquire about increased exposure to ultraviolet radiation and other symptoms related to spinal cord abnormalities.

• Ice Pack Sign: The doctor applies ice over the affected area to observe the patient’s relief from the itching and burning sensation, which reappears after removing the ice application.

• Magnetic Resonance Imaging (MRI): Several radiographic imaging helps diagnose spinal conditions that cause nerve compression. But, the magnetic resonance imaging (MRI) technique provides essential findings for definitive diagnosis.

• Blood Examination: In case the itching of the skin persists for more than six weeks (chronic), the doctor may order a blood work-up to identify an infection or other causative factors.

What Are Conditions That Look Similar to Brachioradial Pruritus?

• Atopic Dermatitis is a chronic skin condition that might occur at age. It causes reddish patches, dryness, cracked skin, and itchiness that increases at night. In addition, family history and other allergies elevate the risk of brachioradial pruritus.

• Dryness Of the Skin may occur due to cold weather and other skin conditions. In severe cases, it leads to cracked or fissured skin, which on further infection, may cause itchiness.

• Neurotic Excoriations also referred to as psychogenic excoriations, are characterized by recurrent picking of the skin. It is associated with underlying mental disorders.

• Notalgia Paresthetica is a severe nerve disorder that causes pain, itching, and burning sensations over the back. The symptoms may range from mild to severe. The doctor will suggest a skin biopsy to diagnose such conditions.

• Zoster Sine Herpete is a viral infection (herpes zoster) caused by the varicella-zoster virus. The unilateral tingling sensation is its classical feature.

How to Get Rid of Brachioradial Pruritus?

Specific measures that are listed down provide temporary relief to brachioradial pruritus.

• Ice packs - Applying ice packs over the affected area provides symptomatic relief.

• Avoiding sun exposure - Avoid outdoor activities that increase the risk of sun exposure, and use protective clothing with long sleeves to decrease sunburn.

• Use sunscreen - Food and drug administration (FDA) has approved many over-the-counter sunscreens that prevent sunburn and protect the skin from harmful UV rays. Ensure the sun protection factor (SPF) is between 15 to 50 for the best results.

• Physical therapy - As suggested by the therapist, specific therapies to strengthen the spine might reduce pruritus.

How Is Brachioradial Pruritus Treated?

The brachioradial pruritus is managed as follows:

1) Oral Medications - The most commonly suggested include Amitriptyline, Tricyclic antidepressants, Gabapentin, Risperidone, Chlorpromazine, Fluoxetine, and Hydroxyzine.

2) Topical Medications - It is found to be more effective than systemic medications and includes:

• Capsaicin-containing creams help in relieving the symptoms.

• Antihistamines block the histamine’s allergic response to external sources, and it helps reduce the pain.

• Anesthetics produce numbness over the affected area. It includes the use of Amitriptyline and Ketamine.

• Many moisturizing lotions contain menthol, a cooling agent, and provide relief from the burning sensation.

3) Surgery - Surgical management is not usually carried out. It is done to correct spinal cord abnormalities that cause brachioradial pruritus in a few cases.

What Is the Prognosis of Brachioradial Pruritus?

There is no such effective treatment in achieving the complete resolution of symptoms. However, the doctor scheduled a course of treatment to control the recurrence of brachioradial pruritus.

What Are the Complications of Brachioradial Pruritus?

Individuals with brachioradial pruritus will have the urge to scratch the skin, and severe scratching leads to the following:

• Loss of skin color.

• Formation of lumps.

• Scarring.

• Eczema (the skin becomes red, bumpy, and itchy).

Conclusion:

The itching or tingling sensation over the skin is a common symptom of most nerve conditions. The healthcare specialist’s knowledge of various skin conditions and their diagnosis is essential in planning the proper management. However, it is the patient’s responsibility to have an early appointment with the dermatologist to identify the cause of any skin condition and prevent its complications.