Brachioradial Pruritus: Orphan Patients in Search of Understanding and Care

Brachioradial Pruritus: Orphan Patients in Search of Understanding and Care

Desire T. Gijima (Mayo Medical School, Rochester, MN, USA) and David J. Elpern (Kauai Foundation for Continuing Education, Williamstown, MA, USA)
Copyright: © 2012 |Pages: 6
DOI: 10.4018/ijudh.2012100106
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Abstract

The authors present a case study around an entity named ‘brachioradial pruritus’ a neurogenic itch which typically occurs on the dorsolateral forearm but may also involve the upper arm and shoulders, and less commonly the back. The disease at this time does not have a known treatment and the authors not only discuss the isolation of these patients which is exacerbated by the ignorance or indifference of most medical personnel to this often debilitating condition but also from their shared learning experiences from a web based platform propose an algorithm that may be useful for others who need to deal with this condition.
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Case 1. 32 Year Old Equestrian

I am an otherwise healthy woman desperately searching for a doctor who may be able to discuss some treatment options for my very itchy arms! I am 32 year old, 110 lb, active, female resident of New England and have been suffering with itchy arms (without rash) for at least four years now. When I finally sought treatment- I was referred by my primary MD to a dermatologist who informed me that I had dry, sensitive skin, and prescribed a topical cream and an oral steroid - I carefully followed his advice for 2 years - with absolutely no relief from the itch. The only thing that relieved the symptoms (which flare more intensely in the evening hours) was ice packs. I was often woken from sleep by the itch.

The itch occurs in cyclical pattern- symptomatic for months, followed by a month or two of none or very mild symptoms, then followed by another flare. It is present in sunny months as well as winter.

Finally, frustrated by the unresolved symptoms, at my own expense, I had one visit with a dermatologist in a nearby large city who very quickly diagnosed brachioradial pruritus and prescribed topical Capsaicin. Capsaicin works - sort of. But, it is a total pain in the butt for minimal relief. I am seeking alternative treatment.....acupuncture, chiropractic, anything ... ? Do I need an X-ray? What do I do? I am on my own out here in a sea of medical professionals who seem unwilling to take this condition seriously or look for possible causes that may be an underlying cause for this condition of itchy arms....

It may also be of interest that I have a large amount of muscle/ligament type tension in my neck and shoulders- it's pretty severe, some of this tension is a manifestation of stress, some results from my very physical occupation as an Equestrian.... I am personally tempted to think that all the tension in my neck and shoulders may have something to do with the arm itch - but this conflicts with the cyclical nature of the itch, as the tension is chronic. To me, BRP is a big deal!

Case 2. 37 Year Old Health Care Professional

I have suffered with this for no less than 5 years. Until about a year ago it was sporadic, but has been substantially worse and constant for the last year or so. Nights are particularly difficult, as the itching becomes intolerable and uncontrollable. I have recently found some comfort with ice packs, but naturally having to traipse off to the kitchen several times a night is inconvenient and exhausting. The most recent prescriptions I have tried are 10 mg cetirizide for daytime and 25 mg doxepin (1-2) at bedtime, and also betamethosone cream. The cetirizide helps with other allergy issues I have, but doesn't offer any relief to the itchy arms. Also, the doxepin helps me get a few solid hours of sleep if I take 2, but as with hydroxizine I feel “hungover” the next morning, and insatiably hungry.

I do love the sun, and have always found that I feel better through the cold months if I go tanning a couple times a week. In the winter months, I spend a bit of time tanning prior to spending any significant time outside in the summer. I have fair skin, and it helps prevent burning before spending a day at the beach (which I do all day as often as possible). I do not, however notice any increase or decrease in the itching based on exposure to sun/tanning. In the last year, however, I have started being a bit more careful and use a minimum of SPF 30 during peak hours at the beach. Here is a recent picture (presented in Figure 1).

I have seen several doctors, including a dermatologist, regarding this debilitating itch and nothing has helped enough to warrant the side effects. I cannot seem to get anyone to understand that it isn't like a skin itch, it feels like it’s UNDER my skin. I scratch so much, especially at night, that I bleed. I am not a crazy, irrational person.... but the loss of sleep and inability to find anything that relieves this itching probably makes me seem as though I am.

Editor's note: This shows some typical findings (Figure 1). The skin looks a bit dry and lichenified and there is evidence of excoriation. Not all cases show these changes, some are more subtle.

Figure 1.

Typical findings for brachioradial pruritus

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