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
Can u please tell me what neck exercises you are doing? ThxMarch 13, 2018 - 9:45am
Hi, it's me again.September 15, 2016 - 1:58pm
OK, my wife and I replaced our foam/latex/rubber mattress for a brand new spring type with a different underlay material. Apart from now getting an even better sleep, $2,500 later the mattress (and removing the electric blanket) made no effect on my itchy arms. So I went to my doctor who after a while chatting and asking me questions diagnosed it as a form of echzema.
He prescribed to me a cream ointment called ADVANTAN 0.1% 15G that should be applied twice daily and very sparingly because it is quite potent. My chemist where I usually go to buy other medicines said it is the best product available on the marketplace. I have been using it for several days now and it works like a charm - itching sensation completely gone and my arms are now repairing themselves and the red irritated skin is gradually disappearing slowly. You cannot just buy this product over the counter and you need to see your doctor and get him/her to prescribe it for you if your symptoms are the same as mine. I really hope it works for you and all the other sufferers having the same problems. My doctor also said avoid stress, get good sleep and rest and eat healthy food and exercise a bit. A healthy appetite leads to a healthy body and ensure you eat your fruits daily. He said DON'T scratch the area as this makes the symptoms worse. Apply some cold packs and don't have hot showers on the affected areas even though it might feel nice - apply some cold water to the areas after a warm shower to soothe the itch.
Good luck and let me know how you get along now. You can Google the data sheet and read the product for safety purposes. Also please don't try and self diagnose - go and see a doctor. That's what they are there for.
Does your insurance cover this cream? It is hard not to itch. Only thing that helps are ice packs. It feels like little bugs are biting under my skin. UggOctober 20, 2016 - 3:33pm
My insurance did cover my gabapentin compound cream. It, along with physical therapy and chiropractic care did the trick for me. And yes - those little 'bugs' under your skin are nerve endings. Ice will numb and quiet them. I hope you ALL find relief!!October 21, 2016 - 7:48am
Hi, it's me again.October 9, 2016 - 4:48pm
Just reporting that after using ADVANTAN 0.1% 15G for 10 days all my itching and scarring tissue caused by the scratching has vanished. I don't have the need to scratch anymore and the itching has gone away. Therefore so far so good and thank ADVANTAN for that. I sincerely hope that it works for you too. Best wishes.
Glad to hear! I googled that cream and it is a steroid cream for our other readers to know. To try it you will need a prescription from your doctor.
take care,October 10, 2016 - 5:39am
Tell your dr you have Brachioradial Pruritus. Most have never heard of it, so you need to give them a little time to get up to speed. If they won't, FIND ANOTHER DOCTOR! I found relief with a compound cream of Gabapentin, lidocaine, ibuprofen and a few other ingredients (if you want the full list, ask). I also did 8 weeks of physical therapy for my neck. This combo WORKED for me. I screwed it up on a trip to Germany (9 days of bad pillows). In back in PT with another round of cream and its working!! I have not iced my arms in almost 2 weeks! I believe this is fixable. My luck was that my new Dr believed me.September 13, 2016 - 4:14pm
Is the cream called GABAPENTIN, or is that simply one of the ingredients? If it's just one of the ingredients, can you tell me what all of the ingredients were that helped you?September 14, 2016 - 2:03pm
I'm pretty sure I have what you mentioned because I just finished some neck therapy with a chiropractor, then one day after being outside a little longer than usual (at a cemetery service) I started the itching on my forearms. Since I live in South Florida I thought it might have been ZIKA. However, even the picture here, with it's pinpoint red dots is exactly like what I have on my skin. I've been getting somewhat decent relief from Econazole Nitrate (1%), or hydrocortisone (1%), or Lanacane (benzethonium chloride .002% and Benzocaine 20%), or Benadryl (diphenhydromine hydrochloride 2% and Zinc acetate 0.1%). Since they all have different ingredients I'm trying to see which works best.
Hello! I hope this reply works - it will be my 3rd attempt to answer.September 15, 2016 - 7:03am
Yes! It is Gabapentin. Here is the cream breakdown: Piroxicam, 0.2 %, Gabapentin, 3%, lidocaine, 2%, prilocaine, 2%, impramine 1%, ibuprofen, 2.4%. My itching has always been worse at night, which makes sense. As gravity pulls you down during the day it compresses your neck and spine (you're always taller in the morning). I am again having very good success with physical therapy, neck traction, chiropractic and the cream. I haven't used the cream at all in 4 or 5 nights. I have never had any alteration of symptoms in the sun or not being in the sun. I shower at night and happen to like hot showers, and sometimes the hot water will aggravate my arms, but because I've been scratching them and the skin is irritated. I'm not discounting the sun theory, I just know for me it's my neck.
I hope you can find a Dr that will listen. I find typically Dr's don't care for it much when a patient has self diagnosed, but after the bristling, my new Dr listened to what I had to say, admitted she wanted to study it further, and gave me what I needed. I was initially surprised at the PT, but it worked! Especially the neck traction. I think that helps a LOT. GREAT luck to you! If I can answer anything else let me know. Hopefully I will be successful in posting this reply!
Thank you for the script ingredients , I had this itching problem last year august thru november, I scratched both arms till they bled, it was god awful. I showed a article to my md about it and he did prescibe a corticosteroid cream and gabopentin. I had a cervical fusion of C3-4 and C 4-5 and the problem disappeared till 4 weeks ago. I have a call out to the neurosurgeon , but I feel that it is another cervical area of C6-7 this time . Taking gabapentin again, and using ice every night . The sun makes it worse, although I was exposed all summer without a problem. I am glad this is not all in my head and other people have this issue. Hopefully we can help each other.October 8, 2016 - 7:11pm