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Brachioradial pruritus (BP) is a condition where the person experiences intense itching, burning and/or stinging to one or both arms. The itching often occurs between the shoulder and the elbow on the sides of the arms but can also extend up to the shoulders.
Scratching can make the itching feel worse, rather than bringing relief. Using ice packs is one treatment that may calm the itch.
Why brachioradial pruritus occurs is unclear. There are two basic mechanisms that are thought to be the cause of this uncontrollable itch.
The first is the solar hypothesis. It is thought that people who have had chronic sun exposure develop an allergic type of histamine response in their skin.
This theory receives some support from the fact that people usually report more left-sided symptom over right-sided. This could be explained by the sun shining more on the left arm while driving.
In South Africa, where drivers sit on the right side of the car, the incidence of BP more frequently affects the right arm. Symptoms also often are worse in the summer and improve in the fall.
The second hypothesis is that BP may be caused by a neuropathy (problem with the nerves), specifically some type of irritation or compression of the cervical nerves in the neck. Treatments for cervical arthritis have shown to improve those with the condition.
This type of itching is called a neuropathic itch. Impulses are sent due to hypersensitivity of the nerve fibers. Sometimes people feel both pain and itching, as well as some type of sensory disruption such as altered sensation in the area.
A 1987 study even suggested that BP may be caused by a combination of the two stating that, “brachioradial pruritus is a photoneurological disorder caused by sun-induced damage to nerve endings that results in pruritus and altered sensation in susceptible individuals.”2
Another dermatology blog suggests that exposure to wind may also contribute.3
However, there are critics to both main theories.
The solar critics point out that people’s faces get just as much sun as the arms, so why doesn’t one’s face develop this problem?
The cervical nerve damage critics point out that cervical neck degeneration occurs in 70 percent of elderly women and 95 percent of elderly men. So without further studies it doesn’t make sense that many other older adults don’t develop this condition.1
Regardless of cause, there are some treatments that may help brachioradial pruritus.
For most people with BP, the itching is prickly and burning, and that can keep them awake at night.
Ice packs are the first best therapy to try to stop the itch.
Capsaicin is a topical cream that is believed to help with pain-related nerve conditions by interfering with the sensory nerves' perception of pain. It may take several weeks for the capsaicin to work.
Sometimes a topical steroid cream can take the edge off.
With a doctor’s prescription, a lidocaine 5% gel or patch can be applied to the skin. Lidocaine provides relief by blocking nerve impulses.
Other oral medications that act to block erroneous nerve impulses such as gabapentin, lyrica or amitriptyline can also be tried. However, they are also fairly sedating and have other side effects, so they may not be well tolerated.
Alternate treatments include acupuncture and topical anti-itch oils such as menthol or spray-on antihistamines, which may give some relief. Oatmeal or black tea tannin compresses may also be of help.
Chiropractic adjustments of the neck have also been found to be helpful by some. Wearing protective clothing such as long-sleeved shirts to protect your arms from wind and sun may help.
Brachioradial pruritus is a very frustrating and difficult condition that requires understanding from others, as well as patience and persistence to come up with some amount of relief.
Michele is an R.N. freelance writer with a special interest in women’s health care and quality of care issues.
Originally written March 2, 2011
Updated August 16, 2016 by Michele Blacksberg RN
Edited by Jody Smith
Article Sources
1) Brachioradial Pruritus. Medscape. Retrieved August 13, 2016.
http://emedicine.medscape.com/article/1355312-overview
2) Berny-Moreno , Joanna, Szepietowski Jacek C.. Neuropathic itch caused by nerve root compression: brachioradial pruritus and notalgia paresthetica. Serbian Journal of Dermatology and Venereology 2009; 2: 68-72.
http://www.degruyter.com/downloadpdf/j/sjdv.2009.1.issue-2/v10249-011-0006-z/v10249-011-0006-z.xml
3) Thoughts about brachioradial pruritus. The Online Journal of Community and Person-Centered Dermatology (OJCPCD). Retrieved August 13, 2016.
http://ojcpcd.com/elpern-d-j/thoughts-about-brachioradial-pruritus
Add a Comment130 Comments
F Y I......So ,i found some relief by mistake after injuring myself playing football....i sprayed my shoulder w this product called "max freeze "...you can pick it up on the shelves in Walmart.....pretty much the only thing that works for me after finding the ice packs just dont work any more. Hope it helps.
September 8, 2015 - 3:59amThis Comment
For me this worked, took forever to figure out. I had bought couch pillows and bed pillows from a discount store. I was allergic to the fill, maybe the cover. I removed them, bought hypoallergenic ones instead, and itch gone. Hope this helps. PS ice helps.
August 31, 2015 - 5:29pmThis Comment
Hello Anon,
Sorry you are having this difficulty. I mention various treatments in the article that might help so that would be a place to start. Ask a doctor about taking low dose Amitriptyline at nite, which will help you sleep and if the itching is nerve driven, might help block those impulses.
Alternatively, perhaps acupuncture or even hypnosis might help.
Based on my article's source and comments from others, the cause could be nerve driven, yeast driven or some other part of the body is affected and the symptoms occur due to those problems.
You might want to keep a food diary or just a diary tracking the symptoms to help you identify when it occurs, how bad on a scale of 1-10 it feels and the quality of the itching/burning sensation e.g.. what you feel most.
The fact you feel it during August to March sounds like something that happens or you do when the weather gets cooler is a clue.
Hopefully you will find other clues about how to figure it out yourself since you have not found doctors who could help you.
take care,
Michele
August 29, 2015 - 6:13amThis Comment
I get this on my shoulders and what helps distract me from the itchy sensation is a muscle relief lotion (kind of like BenGay) that creates that minty cooling sensation on my skin, almost like an ice pack without needing one! And I also take probiotics. I notice that when I forget to take them the itching sensation is worse and more frequent. I had something similar to this at the beginning of the year but it was all over the core part of my body and it was red and inflamed and the more I itched the worse it felt, it was absolutely miserable and depressing. I did a lot of research and realized that it was actually a gut issue and not primarily a skin issue. So I drank kombucha and ate sauerkraut like crazy and it disappeared within days. It was miraculous. I've switched to just taking probiotic pills because I felt like the sugar and caffeine in the kombucha made me break out more. But the pills don't seem to be as effective at keeping my gut balanced... Hence, I believe, the shoulder itch... I should really focus on getting rid of it completely but the pills and lotion are helping me survive it at least.
August 28, 2015 - 3:33pmThis Comment
Turns out I am allergic to milk. I had it for years, and was also lactose intolerant. One time, my lactose intolerance was flaring up, so I stopped drinking milk for a month. I noticed that I didn't get anymore outbreaks when I had no milk in my system. To be sure, I drank milk again, and had a flare up, so I stopped drinking milk again, and the flareups stopped. Its been since 2012 and I haven't had a single flareup....Except for a couple times when I had to have some ice cream.
August 26, 2015 - 2:05pmThis Comment
I have had the same problem for the last 11 years, with all the same symptoms you have mentioned. I have tried most of the same remedies. Recently I found spots inside my lip.
August 13, 2015 - 2:26pmI thought the two things were separate issues, but in seeking a remedy for one, it seems I have found the solution to both. Its caused by yeast. Its worse in the summer because I drink more beer.
if you to stop all yeast containing products, such as beer,bread,marmite etc for two months and eat plenty of yoghurt with pro-biotics from any decent health food stores, it should go away. It seems to have worked for me. I live in Portugal where its hot. I thought I had a problem that was caused by heat for years, but quite by accident I stumbled on the solution.
This Comment
Absolute living hell. For about 2 years this affected both my outer forearms near the elbows. when it first came on the itching was so intense I dug well into my arms and was pouring straight rubbing alcohol on the wounds to try desperately to turn the itching into a pain sensation (which was preferable). I finally got in to see a doctor who immediately prescribed a fairly high dose of Doxepin (which worked immediately). (My doctor told me that Doxepin is the generic of Sinequan, the drug they give recovering heroin addicts to remove the itchy crawly sensation from their skin as they detox). it is a very powerful tricyclic antidepressant that happens to have this skin side effect.) The doxepin took all skin sensation away - it was odd - I could not feel me touching my own skin. I was also a zombie and good for absolutely nothing while on that medication but I was so desperate for relief I was grateful. I took doxepin for a month per doctors orders. After that the doc put me on 'regular' antidepressants - which helped - first generic prozac then generic celexa. He explained that this was some form of 'atopic' or contact dermatitis that was probably caused by depression / anxiety. I agreed that I did suffer from depression and anxiety and was ok with taking the antidepressants. I disagreed with him about the exact cause or trigger for the itching and we had a long, intelligent discussion about this. Exposure to DIRECT sunlight here in Florida would trigger it - it started suddenly and with no warning. I thought I had gotten some kind of bug bites after gardening outside. I had a minor car accident a few months later, hurt my neck and back, the symptoms grew dramatically worse. I had some back trauma 10 years ago. I also suspect there is some connection with both neck/back nerve injury and exposure to the sun / solar radiation (plain heat will not trigger it). At the time of onset I was not on any medications at all. That was when I found some article on the web relating to brachioradial pruitis - and I brought them in to see my doctor. He had not seen that information before and agreed this looked liek what I am suffering from. I was able to manage Flare ups (successfully) by slathering the affected areas of my arms with LANACAINE (over the counter skin ointment / cream in a yellow tube, only certain drug stores carry it) contains 10% benzocaine. No side effects except for some localized skin numbness. It's been years now and I STILL keep an emergency kit in the car / house / wherever just in case. The itching went away on it's own. I am off antideppressants for about 9 months now (but am now taking medication for hypothyroid). It has been 4 years now since the itching vanished. I am very grateful. But I live with a quiet fear always that it may someday return. I am able to go out into the sun with no itching But I don't push my luck and spend all day at the beach or anything like that. I am cautious.
SO - TO RECAP:
June 16, 2015 - 4:50pmLANACAINE WORKS FOR FLARE-UPS.
DOXEPIN / SINEQUAN WORKS FOR ACUTE CHRONIC EPISODES.
GET EFFECTIVE CHIROPRACTIC OR SURGICAL CARE FOR ANY NECK / BACK RELATED INJURIES where anything may be pressing on the nerves, even slightly.
STAY OUT OF THE DIRECT SUNLIGHT.
This Comment
I have had this affliction for 38 years and ice packs were the only thing that helped. I tried cannabis infused coconut oil (1 teaspoon at night) and have been itch free for over 8 months. My neurologist tried 21 different medications on me, some were heavy anti-psychotic crossover meds that really made me feel horrible.
June 12, 2015 - 5:02amI never thought in a million years that cannabis would help eliminate my itching.
There is also another product that will give you temporary relief. It is Kwan Loong Pain Relieving Aromatic Oil available on Amazon for about $10.
Good luck!
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Just a question about the cannabis oil, are you ingesting the cannabis or rubbing the oils on your skin?
June 18, 2015 - 6:14amThis Comment
both, I mix the oil with Kwan Loong Pain Relieving Aromatic Oil and use an ice pack if needed. You need to break the itching cycle before it gets bad or it is difficult to manage. Ice pack and use an Ace bandage about 4" wide. But the gel ice packs on Amazon. They are the best. I have about 5 in the freezer.
August 14, 2015 - 8:52amThis Comment