Introduction
Brachioradial pruritus is a neurogenic itch syndrome of the upper extremities. The pruritus experienced by patients with brachioradial pruritus is believed to be a variant of pain. The itch of brachioradial pruritus is described as intense, burning, and prickling. It is typically localized to the skin on the dorsolateral forearm overlying the proximal head of the brachioradialis muscle, but involvement of the upper arms and shoulders is also common. It may be unilateral or bilateral. Scratching reportedly only makes the discomfort worse and many patients find that the only therapy that brings relief is the application of ice packs or cold, wet towels. Lidocaine 5% gel or patches are also often a therapy that can provide symptomatic relief. The discomfort is typically worse at night and, for some patients, may interfere with falling asleep. The median duration of symptoms has been reported as 4.5 years, but patients have reported a continuation of symptoms from this condition for as long as 18 years. Despite the severity of symptoms, no associated erythema or skin eruption is seen. Evidence of excoriation or lichenification may be present in the affected areas. Biopsy of skin reveals atrophy and signs of sun damage, along with reduced numbers of both dermal and epidermal nerve fibers. Evidence exists that this reduction in cutaneous innervation occurs only during symptomatic flares, with innervation normalizing during symptom-free periods; thus, biopsy should ideally be performed when patients are actively experiencing symptoms. The condition appears to represent a primary neuropathy. Abnormalities in cutaneous innervation have been documented. The possibility of an underlying neuropathy should be considered in the evaluation and treatment of all patients with BRP.
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