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
1) Brachioradial Pruritus. Medscape. Retrieved August 13, 2016.
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.
3) Thoughts about brachioradial pruritus. The Online Journal of Community and Person-Centered Dermatology (OJCPCD). Retrieved August 13, 2016.
Add a Comment130 Comments
I live in georgia and I am outisde (a serious cyclist} in sun a lot. I only get this in the summer. It comes on and I itch a little for a few hours. Then it stops and then after a few days I havetiny bumps. Then the bumps itch and then they bleed. Then I get a scab which also itches and I must scratch in my sleep because the scabs bleed. From that first itch until when it heals takes 3-4 weeks!!! It's terrible! I get about 6-8 outbreaks every summer. Its only June first and I have a few big scabs on my right arm already. One outbreak so far on the left. It stops for awhile and then comes back! In fall and winter I am fine! It must be the heat!June 1, 2015 - 6:35pm
AnonymousJune 1, 2015 - 1:34pm
I recently started experiencing an extremely itchy forearm. It is more predominate at night for some reason. Putting topical itch cream on the area seems to help. I play a lot of tennis so I am in the sun at least four days a week. But I wondered if it could be brought on by stress as well, like the shingles virus. It helps to know I'm not alone.
Hi I hurt my neck two years ago and had pressure on my nerve. my right arm started itching at nite when I relaxed. My chiropractic fixed it pretty good . In the last month I have hurt my neck in the same way and the itching has started again. I find this so amazing I also get really bad pins and needles when I finsh work . Thanks for the insiteMay 7, 2015 - 2:30am
I have been suffering with this condition for over a year. There have been many nights of an incredibly itchy forearm. I have scratched it until it bled previously. Now I TRY to just use China gel or ice packs. My condition is on my left arm which makes sense due to the fact that I'm a mail carrier in Florida. Drives me absolutely bonkers!April 29, 2015 - 9:11pm
Thank you for your article. I too have started this crazy itch in my forearms 3 months ago. Exactly as your article states it, my left arm is worse then my right however they both have terrible rash and a rating scars.
I live in Hawaii, and am 54 years old.
I dont know yet what the triggers are but there is definitely a problem. I also do have arthritis on my upper spin, and neck.
I did see a Allergist and Dermatologist and I mainly took antihistamine meds and Steroid cream.
Most of the rash has calmed down but a area on my upper left arm is taking forever to heal. It still itches at night.April 29, 2015 - 2:50am
I get this also mainly right forearm and up to the shoulder, I will also note when I do have this and apply a bit of thumb pressure to the area, it is quite tender and yet I have been off work for a few weeks and doing nothing heavy, ?? am here in Brisbane Australia, plenty of sun , but that is always the case.April 18, 2015 - 3:00am
I've been experiencing this type of itching on my upper arms consistently for the last year and a half, since moving to central California from the Pacific Northwest. I've often had my arms exposed in the PNW sun, but it isn't nearly as intense there. I don't intentionally tan, but do wear tank tops more often. I've never had the problem before and immediately equated it with increased sun exposure on my upper arms as soon as the symptom began to appear. My skin on my upper arms also seem to feel thicker and have less topical sensation. I'm mentioning this here because the article talks of the debate about whether sun plays a part and for me, it seems it has. As far as I know, I do not have any cervical or spinal disorders and currently I'm 46. So far I haven't tried many things to relieve the symptoms, so I don't have anything to offer there, but I do hope that the information I have offered can be useful.March 16, 2015 - 5:35pm
Thanks for your input anon.
I hope it settles down.
MicheleApril 6, 2015 - 1:20pm
I suffered with this in 2013. It came on for no reason. I was put on 100 mg IC Gabapentin and it seemed to fix the problem completely. I went all of 2014 once again systom free. This year, I went to Costa Rica in February and did get sun exposure. It has now been 6 weeks that I have once again found myself suffereing from it. I am back on the IC Gapentin, however, it has not gotten rid of the problem as of yet. My doctor has increased the dose and I am so frustrated as there seems no 'sure way' to know what triggers it. I live in the Boston area so I have not been exposed to any sun since February. I can go a few days without any itching and then BOOM...it comes on full force and drives me totally crazy for several hours at a time. I do, then, put on ice and it does help. I think it just freezes the arm and the nerves and that is why the relief. I just wish I knew if there was another way that it is triggered. I just turned 55 and had never had this problem until recently. Like I said at the beginning, the thing that makes NO sense to me is why after I suffered for one whole summer, why the next year I was totally symtom free only to be once again feeling like this is controlling my life. It is not only extremely itchy but painful and I feel like my arm is like leather as I scratch it so much. HELP!April 6, 2015 - 12:24pm
Triggers and nerve pain can be like that. It is frustrating why do nerves respond to something one time but then do not respond when it appears that the same situation is repeated? It may be something else is the driver to keep your itching happening. Perhaps it is your diet or your detergent you use to wash your clothes.
I assure you it can be a very small thing that is setting things off. And it is also not uncommon for a nerve calming medication to work for a while then stop working. I wonder if some topical compounded cream that has lidocaine might help or even a topical creme that has Gaba or elavil (another med used for nerve pain/sensitivity) might help.
You might want to see a chronic pain doctor just because they are experienced in choosing other meds to try. I do suggest you call a compounding pharmacy close to you (google compounding pharmacy) and ask to talk with a pharmacist and see what they suggest. Then if your primary dr is willing, he can write a prescription for some topical medication to try.
MicheleApril 6, 2015 - 1:26pm