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'd like to share my insight into BRP. I'm a 30 year old white male, going on almost 10 years of this seemingly seasonal, insane itch. I havnt noticed it every year since I first noticed it, this year has by far been the most severe. I've never had any serious head, neck, back injuries or surgeries. I've had some sunburn on my body, including forearms in my life.. maybe quite a bit, but not as much as someone who lived in a warm area and spent tons of time on the beach.
I have always held tension and had strong anxiety, probably relating back to emotional insecurity habits started in childhood. I've always been a bit quiet and shy, and probably "held in" a lot of mental and physical things. I noticed recently I've had Forward Head Posture for a long time in my life, meaning I did not have proper posture in how I held my head on my shoulders. I developed snoring, which became sleep apnea, low back tension, and cervical spine tension. I imagine as I held my head forward throughout life the rest of my spine gradually started to clench to compensate for the improper posture near the neck.
Now, back to BRP. I've tried creams, I've tried scratching, I've done the ice packs. I want to CURE, not TREAT this madness, as we all do. I began to start with proper head and neck posture, making sure my, particularly my C5-C7 vertebrae were not bunched up and compressed. I began proper diaphragm breathing, in through the nose, and also out through the nose (to simultaneously help with anxiety and sleep apnea). I noticed an IMMEDIATE relief in my anxiety, my mental pace, and my airway blockage. I began doing certain cervical spine yoga stretch routines and noticed an IMMEDIATE relief in BRP symptoms.
Yes, as you begin to correct your posture your upper back and shoulder muscles have to work in new ways, and can get fatigued. When I need to rest I lay flat on my back, no pillow, with my head in the same posture I work on while sitting and standing. I breath deeply into this feeling and try to release as much as possible.
I have focused on my posture while driving, sleeping, sitting, typing, standing, and even how I look at my cell phone and tablet devices. I hold them up to my eyes, rather than drop my head down to them.
Chin tucked, back of the skull lifts, drop your shoulders down and back. You don't want a perfectly straight neck, a gentle concave curve is normal. If posture has been causing your BRP, like I believe it has for me, you will notice a larger than normal knot around your C5-C7 vertebrae, basically between the tops of your shoulders. Look at yourself in the mirror from the side, do you resemble the hunchback of notre dame a bit? :) I know I did (I say this somewhat exaggeratedly).
Whether your are into spirituality, yoga, eastern medicine energy thoughts or not, you WILL notice circulation sensations reaching EXACTLY where the BRP itch is when you start to correct your posture. This is your body telling you you are on the right track!
Let your belly hang out, its beautiful, I've got one! Lift your chin, let your chest proudly go out, release all your held tension that isnt necessary for standing up. Breath at an even pace, do all your activities at an even pace (other than exercise) and keep your posture in check throughout the day, constantly!
I've noticed better circulation, less obstructed airways, and best of all, relief to my damned itchy arms.
Posture is key, especially in our head region. Our heads are essentially 11 or so lb bowling balls resting on a delicate stick. Even just slightly having our head forward, over time, many years/decades, will gradually stress the neck and back out a LOT. We also drive and sit at desks a lot in our society, this adds to this unhealthy habit.
Every doctor I went to didnt know jack about BRP and wouldnt acknowledge it. They insisted it was eczema, dry skin, allergies. I have incredibly oily skin and my doctor still tried to convince me I had dry skin. Creams that will destroy your skin if you use them for too long are NOT the answer. They only treat anyway, not cure.December 4, 2016 - 10:38am
Thank you for this very informative post about BP. I've had this terror in my arms for 12 years! Ice packs when it comes are the only things that enable me a little sleep and some sanity during the days. I did have a car accident many years ago and crushed my T6 & 7 vertibra. I also play golf which probably doesn't help. At least I have something to go on now. I'll look for a chiro who can perhaps do something in my neck. I agree about the creams although there are times when I'd put literally anything on the itch to stop it. I use wrist sweat bands to hold icy poles next to my forearm. I get this about twice a year for about 6 weeks at a time but only on one side or the other. Usually on my forearms but i have scars too on my upper arms. I'm from south Australia and the season doesn't make any difference as i have it right now and it's cold and wintery.July 30, 2017 - 1:20am
Thanks for your suggestions. ..I'll follow it up.
What has given my wife relief, is what gives everyone relief. Cold….
Her favorites over the last 8-9 years are (for the day time), the Rite-Aid Reusable Cold Packs that have the bubbles that freeze(Similar to the CryoMAX Reusable Cold Packs - Likely at any Rite-Aid type store). These last for a long time and she can put a light cloth between or over a light shirt, will protect her are.
For the evenings, she uses packs similar to "Nature Creation Relief Packs". We have both the bubble cold packs and these cloth packs in our freezer. Note: There are quite a few sites for DIY or you can even pick them up from Goodwill at times. Depending on the size of your itching surface, you can choose between the shoulder wraps, back packs, etc… Any of those well built packs, can be frozen and for my wife, weren't so cold to damage the skin. The day bubble packs could get too cold and she didn't like to use them at night. At times at night, she would have to get a fresh cold pack from the freezer in the middle of the night if it was an extreme night.November 16, 2016 - 2:01am
So, I am writing this from a spouse's perspective.
My wife has had this issue for the last 8-9 years. Summer unbearable itching that calms near winter, colder months. Exactly what is described in this article and forum.
My first request is for a personal request for the name of a doctor in the Southern California area, near North OC area (Anywhere within the few surrounding counties). Please personally message me with the name of a local doctor that we won't have to convince or educate them around BP - Brachioradial Pruritus. I would like to find a physician that has the option to provide the (Piroxicam .2%; Gabapentin 3%; Lidocaine 2%; Prilocaine 2%; Impramine 1%; Ibuprofen 2.4%) and/or Advantan 0.1% 15G compound cream ointment or anything that is topical that can provide my wife relief.
I have no problem letting a physician diagnose the issue and determine the best protocol for the problem. What I have an issue with, is "turning/educating" a physician around. That their 4-5 options they know for these symptoms, don't work. They aren't broadening their scope of issues/solutions enough to resolve the problem. Most physicians run out of ideas and turn to depression and psychological drugs, which is frustrating when you can't sleep, wanting to take a steak knife to your arm, etc... This problem is similar to Fibromyalgia back just a few years ago. Doctors/Physicians used that, once they came up with the word, as a garbage can until just a couple of years ago. It was always viewed as mental instability and psychological problems. The sad thing is, once you get FM and other Auto Immune Issues, you become more susceptible to more problems being lopped on....
This issue is tough to watch a loved one go through because you need to eat well, exercise, sleep well, etc… Those that have this, know that the itching doesn't stop at bed time, it ramps up. Once you stay up going crazy with this itchy arm, it piles up and doesn't allow you to freely exercise, sleep well, etc..November 16, 2016 - 2:00am
Me too!November 20, 2016 - 2:46pm
I am in agony all day and all night. Would like to rake both arms, constantly. It came on suddenly, so it seems. Arms are scarred-up.
Hello SpearFishing 1,
I am sorry your wife has had such difficulty but glad she has at least found a couple of things that help her.
I do not know of a doctor to help in So. Cal but what I suggest people do is go to Castle Connelly's website to find doctors in the speciality area and part of the country. You want to get the names of those to call and determine if they have knowledge to help you.
Their website: https://www.castleconnolly.com
Call a found doctor's office and ask to speak to either a nurse manager or the most experienced nurse in the office to determine if the doctor has experience in the area you need.
A word about drugs that are for depression. Some of those depression drugs such as Elavil have properties that make them reduce nerve driven pain. Itching can be from nerve irritation so don't write off trying one of these types to block those erroneous impulses that are perpetuating the itch.
The direction to pursue in terms of finding a doctor is to try and determine if the problem is dermatologically driven or neurologically driven. If it is neurological, then a chronic pain doctor may also be worth visiting.
Let us know how it goes,
Thank you very much Michele for the feedback. I really appreciate your feedback and guidance. I hope to provide you positive details soon.
Thanks,November 17, 2016 - 12:10am
i have been dealing with this for thirty years now, but my itch seems somewhat different. every year seems different. my itch is always above the elbow, my shoulders and this year the back of my neck, between the shoulders. but now it has moved to my left shoulder and upper arm. it always starts in august and lasts 2 or 3 months. ice and ice only is my only relief. early in the summer i don't itch and i'm in the pool a lot, but once i start to itch i can't let the sun hit my arms or it starts itching worse. if i had to deal with this all year i think i would put a gun to my head! thanks everyone for all your ideas.September 17, 2016 - 4:12pm
It is so frustrating to try to tell someone or even my doctor & they look at me like I'm crazy! I've had one doctor tell me that I am crazy that I need a shrink to get to the bottom of why I am making myself itch!!! I said if it was in my head I would be the first person to say I need a shrink ,because this itching is driving me nuts!!! I work in construction so I itch all summer long, I get some relief efforts by middle of winter, I have scars from where I itch myself open at night, not realizing I'm doing it!! Please tell me how do I get a doctor to listen to me??? I feel like sometines ripping my skin off , I know that wouldn't help but I just can't take it anymore!!!September 13, 2016 - 2:11pm
Gabapentin was the only thing that worked for me untilOctober 17, 2016 - 7:40pm
recently when I attended physiotherapy for a pulled muscle
In shoulder.. I was given neck exercises which seemed to
stop the tingling/ burning / itching in the nerve endings.. I have
to do them daily or it comes back.. I think bad posture
contributes to this as does sun exposure.. It's always triggered
after I come back from a foreign holiday.. Hope this helps.. Helen