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
If the itching has become this severe, (that you need to slap yourself for relief) an evaluation by a physician is needed. Itchy skin can also be a symptom of an underlying illness or disorder. So it's important to see a doctor and/or a dermatologist for a proper diagnosis if nothing you have tried topically thus far has helped.
Keep us updated
HelenaSeptember 9, 2018 - 10:53am
Anonymous- I wholeheartedly agree with Helena. You need to see a Dr. I had some relief with a temporary application of gabapentin. You could mention that. I’m very surprised ice didn’t help. It’s the only thing that helped me. (Along with the gabapentin). I am in the camp that believes BRP is caused by improper neck alignment (weather and temperature made zero difference to my itching). I started seeing my chiropractor, I sleep with a side-sleeper pillow (which travels with me), and a zip lock bag for ice in case it returns. I’ve been itch free for over a year (knock wood), and I’m so grateful for this forum. Knowing I wasn’t crazy was a huge relief!September 9, 2018 - 11:45am
If your doctor is dismissive about your itching, find another one. That’s common among us.
Good luck to you!
Hi, it's me again.August 12, 2018 - 6:43pm
Well here in Perth WA it is still winter and the BP symptoms are trying to come back again. This is now routine for me for the past 3 years so it tells me that the symptoms are related to the colder weather, ie the inherently cold dry air characteristic of winter months. It only affects my forearms around the elbow area and usually the right arm only and not the left arm as much. I apply Advantan cream and the itchiness etc goes away within a day. I will get relief for about a week or sometimes 2-3 weeks or more and it might try and reappear. I just apply a small dab of Advantan cream and rub it into my skin and presto it goes away again.
See your doctor for a diagnosis and ask your doctor if Advantan cream is beneficial for you. Hope you find some relief and a cure soon. Also as a possible aid, try doing some moderate daily neck and shoulder exercises.
I discovered for myself that two bottles ice pack each arm..just helps me to get some relief from the pain of stings and itch. Whew! glad others out there.July 3, 2018 - 1:48am
I have had BP for about 13 years, it went undiagnosed until about 3 years ago when I heard a doctor talking about it on NPR and went to see a neurologist. Mine is typically on the right arm and horrible during the summer months at night which in SoCal is many months. Ice temporarily helps. I have been taking lyrica for the past 3 years and that has provided the most relief I have found. Right now I have BP on my left arm which is atypical for me and even at 150 mg the lyrica isn’t helping as much as it has the past few years. I usually take 50 mg at night during the cooler months and up to 150 mg at night and 25-50mg in the morning during the hotter months. It is an awful disorder! I used to wake up scratching 3 times a night. Lyrica has been very helpful, I may just need to increase the dose this year. I have a tens type unit and will give that a try as well.June 26, 2018 - 9:39pm
I am so happy to finally be reading this! I went to a dermatologist and then an Allergist and have had no relief! I didn’t know what I had going on even had a name. I too live California and right now Im dying!!! I even got a cortisone shot but still itch!August 11, 2018 - 8:49pm
I have had Brachioradial Pruritus for many years. It normally flairs up several times a year but having moved down to Florida recently it has become more persistent. It is brutal and yes, only ice has helped. Fortunately the ice works every time for me. I've looked for additional ways to treat this and have found one that I am beyond happy to report works for me every time I have used it.
Either right as or right before I normally would feel the itching coming on I put Clove Essential oil on the area that has recently been itching. I say recently as the area seems to migrate over time. This knocks out the itch I'm having and if put on proactively at night, for the first time ever, the itch does not begin at all. It might be something you'll need to do several times a day. This has worked for me but no guarantees it will work for others. I never post but it has been so unbelievably helpful to me, and such an intractable problem that I wanted to put this out there. It's also not that expensive.
Here is a quick description of the benefits of Clove Oil I just pulled off of a simple Google search:
"The germicidal properties of the oil make it very effective for relieving dental pain, toothache, sore gums, and mouth ulcers. It contains eugenol, which has been used in dentistry for many years".
There are many other applications but this seems to be the most relevant. Remember it should be Clove Essential oil straight. This can be pretty strong and there might be some burning (not for me). Some people love the smell - others not so much. I don't mind it and certainly the benefits significantly outway any aversion you may have to the odor (which can be masked with other oils or perfumes).
If this works, please spread the word. Never been more relieved to find a cure to anything. Hope it works for you.December 29, 2017 - 7:56am
Remember clove oil is toxic and over use or use on broken skin can make you very sick. I have used it on "the crazy itches" and on gauze for dental pain. It has a anesthetic affect, similar to Bonjella but stronger.
I have found my Aloe Vera plant very effective (not the creams). Cut an outer leaf, use a blade or vegie pealer to remove the spikey sides, peal the inner side of the leaf with your fingers. A gooey sticky gunk will reveal itself. Try not to touch it (if on fingers, it slides everywhere,) but put the whole leaf gunk side on the itch and firmly bandage it in place.
Your skin will absorb the gunk and the leaf will dry out. If still itchy, replace with a freash leaf. Leaves do not regrow, so use the entire leaf until you need another, or seal it in something airtight and refrigerate the unpealed part of the leaf for later use. It will have a 2-3 day fridge life. Applied cold (not frozen) is instant relief.
Your skin may turn white, but once the Aloe is stopped, your skin will return to 'normal' colour after a day or two uncovered. The Aloe leaf will only work where you put it. The gunk is is not like cream you can spread.August 25, 2018 - 12:10am
I went to a dermatologist and was informed that I have Brachioradial Pruritus. She said that Gabapentin has been used to reduce/remove the constant itching during the flare-ups. It definitely works for me and has brought the itching to a complete stop (especially during the cooler seasons). During the heat of the summer, the itching may try to come back, but the Gabapentin gives me about 98% relief.November 14, 2017 - 2:03pm
I am currently in remission (yay!) but I assume this is temporary and that my itchy arms will someday return. I continue seeing my chiropractor, and still have ice packs standing by in the freezer. This link was sent to me by a friend, and I find it interesting. I hope you do, too.
https://www.dermnetnz.org/topics/brachioradial-pruritus#.WftNnWLSURE.emailNovember 2, 2017 - 6:44pm