Treatment of Brachioradial Pruritus: A Systematic Review
Main Article Content
Keywords
Brachioradial pruritus, solar, forearm, neuropathic, itch, treatment
Abstract
Abstract
Importance: Brachioradial pruritus (BRP) is a poorly understood disease and can severely impact quality of life. However, there is currently no clear treatment.
Objective: To identify effective behavioral, topical, oral, and invasive treatment options for BRP, and to discuss the quality of the data currently found in the literature.
Evidence Review: The PubMed and CINAHL databases were systematically reviewed for articles from 1968 to the present containing search terms “brachioradial OR solar OR forearm AND pruritus OR itching.” Results were narrowed to articles written in English, focusing specifically on BRP, and that stated precise treatment modalities. Evidence quality was determined based on the study type.
Findings: Thirty-six articles discussing treatments for BRP are included in this review with a total 399 patients. Six studies (n=68) report on the efficacy of capsaicin cream, eight studies (n=26) on oral gabapentin 300 mg daily to six times daily and four studies (n=98) on sun protection. The remaining articles comprise of low-quality, small-scale studies on further oral medications, physical therapy, minimally-invasive procedures, and surgery.
Conclusions and Relevance: Low-quality evidence supports the use of sun protection, topical capsaicin, or oral gabapentin as effective therapeutic modalities for BRP. Clinicians should be aware of possible underlying cervical spine pathology and include thorough imaging as part of BRP work-up. Further high-quality studies on BRP treatments would help elucidate clear management for this disorder.
References
1. Waisman M. Solar Pruritus of the Elbows (Brachioradial Summer Pruritus). Arch Dermatol. 1968;98(5):481-485. doi:10.1001/archderm.1968.01610170041006.
2. Walcyk PJ, Elpern DJ. Brachioradial pruritus: a tropical dermopathy. Br J Dermatol. 1986;115:177-180. doi:10.1111/j.1365-2133.1986.tb05714.x.
3. Marziniak M, Phan NQ, Raap U, et al. Brachioradial pruritus as a result of cervical spine pathology: The results of a magnetic resonance tomography study. J Am Acad Dermatol. 2011;65:756-762. doi:10.1016/j.jaad.2010.07.036.
4. Pinto ACVD, Masuda PY, Wachholz PA, Carlos A, Martelli C. clinical, epidemiological and therapeutic profile of patients with brachioradial pruritus in a reference service in dermatology. An Bras Dermatol. 2016;91(4):549-551.
5. Mirzoyev SA, Davis MDP. Brachioradial pruritus: Mayo Clinic experience over the past decade. Br J Dermatol. 2013;169:1007-1015. doi:10.1111/bjd.12483.
6. Masuda PY, Martelli ACC, Wachholz PA, Akumatsu HT, Martins ALGP, Silva NM. Brachioradialer Pruritus - deskriptive Analyse einer brasilianischen Fallserie. JDDG - J Ger Soc Dermatology. 2013;11(6):530-536. doi:10.1111/ddg.12009.
7. Veien NK, Laurberg G. Brachioradial pruritus: A follow-up of 76 patients. Acta Derm Venereol. 2011;91(2):183-185. doi:10.2340/00015555-1006.
8. Robbins BA, Schmieder GJ. Brachioradial Pruritus. Treasure Island (FL): StatPearls Publishing; 2017.
9. Steinke S, Gutknecht M, Zeidler C, et al. Cost-effectiveness of an 8% capsaicin patch in the treatment of brachioradial pruritus and notalgia paraesthetica, two forms of neuropathic pruritus. Acta Derm Venereol. 2017;97(1):71-76. doi:10.2340/00015555-2472.
10. Wachholz PA, Masuda PY, Pinto ACVD, Martelli ACC. Impact of drug therapy on brachioradial pruritus. An Bras Dermatol. 2017;92(2):281-282. doi:10.1590/abd1806-4841.20175321.
11. Pereira MP, Lüling H, Dieckhöfer A, Steinke S, Zeidler C, Ständer S. Brachioradial pruritus and notalgia paraesthetica: A comparative observational study of clinical presentation and morphological pathologies. Acta Derm Venereol. 2018;98:82-88. doi:10.2340/00015555-2789.
12. Wallengren J. Brachioradial pruritus: A recurrent solar dermopathy. J Am Acad Dermatol. 1998;39:803-806. doi:10.1016/S0190-9622(99)80074-7.
13. Knight TE, Hayashi T. Solar (Brachioradial) pruritus - response to capsaicin cream. Int J Dermatol. 1994;33(3):206-209.
14. Barry R, Rogers S. Brachioradial pruritus - An enigmatic entity. Clin Exp Dermatol. 2004;29:637-638. doi:10.1111/j.1365-2230.2004.01642.x.
15. Goodless DR, Eaglstein WH. Brachioradial pruritus: Treatment with topical capsaicin. J Am Acad Dermatol. 1993;29(5):783-784. doi:10.1016/S0190-9622(08)81703-3.
16. Lane JE, McKenzie JT, Spiegel J. Brachioradial pruritus: a case report and review of the literature. Cutis. 2008;81:37-40.
17. Zeidler C, Lüling H, Dieckhöfer A, et al. Capsaicin 8% cutaneous patch: A promising treatment for brachioradial pruritus? Br J Dermatol. 2015;172:1669-1671. doi:10.1111/bjd.13501.
18. Poterucha TJ, Murphy SL, Davis MDP, et al. Topical amitriptyline-ketamine for the treatment of brachioradial pruritus. JAMA Dermatology. 2013;149(2):148-150. doi:10.1001/2013.jamadermatol.646.
19. Carvalho S, Sanches M, Alves R, Selores M. Brachioradial pruritus in a patient with cervical disc herniation and parsonage-turner syndrome. An Bras Dermatol. 2015;90(3):401-402. doi:10.1590/abd1806-4841.20153059.
20. Heyl T. Brachioradial Pruritus. Arch Dermatol. 1983;119:115-116.
21. Winhoven SM, Coulson IH, Bottomley WW. Brachioradial pruritus: Response to treatment with gabapentin. Br J Dermatol. 2004;150(4):786-787. doi:10.1111/j.0007-0963.2004.05889.x.
22. Kanitakis J. Brachioradial pruritus: Report of a new case responding to gabapentin. Eur J Dermatology. 2006;16(3):311-312.
23. Bueller H, Bernhard JD, Dubroff L. Gabapentin treatment for brachioradial pruritus. J Eur Acad Dermatology Venereol. 1999;13:227-230. doi:10.1093/jahist/jav675.
24. Yilmaz S, Ceyhan AM, Baysal Akkaya V. Brachioradial pruritus successfully treated with gabapentin. J Dermatol. 2010;37:662-665. doi:10.1111/j.1346-8138.2010.00830.x.
25. Crevits L. Brachioradial pruritus-A peculiar neuropathic disorder. Clin Neurol Neurosurg. 2006;108:803-805. doi:10.1016/j.clineuro.2005.12.001.
26. Atış G, Bilir Kaya B. Pregabalin treatment of three cases with brachioradial pruritus. Dermatol Ther. 2017;30:1-3. doi:10.1111/dth.12459.
27. Vestita M, Cerbone L, Calista D. Brachioradial pruritus in a 47-year-old woman treated with pregabalin. G Ital Di Dermatologia E Venerelogia. 2016;151(6):727-728.
28. Rongioletti F. Pruritus as presenting sign of cervical rib. Lancet. 1992;339:55.
29. Abbott L. Neuropathic pruritus. Australas J Dermatol. 1998;39:198-200. doi:10.1093/jahist/jav675.
30. Ally MS, Gamba CS, Peng DH, Tang JY. The use of aprepitant in brachioradial pruritus. JAMA Dermatology. 2013;149(5):627-628. doi:10.1001/jamadermatol.2013.170.
31. Kavanagh GM, Tidman MJ. Botulinum A toxin and brachioradial pruritus. Br J Dermatol. 2012;166:1147. doi:10.1111/j.1365-2133.2011.10749.x.
32. Goodkin R, Wingard E, Bernhard JD. Brachioradial pruritus: Cervical spine disease and neurogenic/neuropathic pruritus. J Am Acad Dermatol. 2003;48:521-524. doi:10.1067/mjd.2003.203.
33. Weinberg BD, Amans M, Deviren S, Berger T, Shah V. Brachioradial pruritus treated with computed tomography-guided cervical nerve root block: A case series. JAAD Case Reports. 2018;4(7):640-644. doi:10.1016/j.jdcr.2018.03.025.
34. Crane DA, Jaffee KM, Anjana K. Intractable Pruritus After Traumatic Spinal Cord Injury. J Spinal Cord Med. 2009;32(4):436-439.
35. DeRidder D, Hans G, Pals P, Menovsky T. A C-fiber-mediated neuropathic brachioradial pruritus. J Neurosurg. 2010;113:118-121. doi:http://dx.doi.org/10.3171/2009.9.JNS09620.
36. Orton DI, Wakelin SH, George SA. Brachioradial photopruritus - A rare chronic photodermatosis in Europe. Br J Dermatol. 1996;135:486-487. doi:10.1111/j.1365-2133.1996.tb01523.x.
37. Armstrong DKB, Bingham EA. Brachioradial pruritus - An uncommon photodermatosis presenting in a temperate climate. Dermatology. 1997;195:414-415.
38. Tait CP, Grigg E, Quirk CJ. Brachioradial pruritus and cervical spine manipulation. Australas J Dermatol. 1998;39:168-170.
39. Wallengren J, Sundler F. Cutaneous Field Stimulation in the Treatment of Severe Itch. Arch Dermatol. 2001;137:1232-1325. doi:10.1001/archderm.137.10.1323.
40. Stellon A. Neurogenic pruritus: An unrecognised problem? A retrospective case series of treatment by acupuncture. Acupunct Med. 2002;20(4):186-190. doi:10.1136/aim.20.4.186.
41. Wallengren J, Sundler F. Brachioradial pruritus is associated with a reduction in cutaneous innervation that normalizes during the symptom-free remissions. J Am Acad Dermatol. 2005;52:142-145. doi:10.1016/j.jaad.2004.09.030.
42. Pereira MP, Lüling H, Dieckhöfer A, et al. Application of an 8% capsaicin patch normalizes epidermal TRPV1 expression but not the decreased intraepidermal nerve fibre density in patients with brachioradial pruritus. J Eur Acad Dermatology Venereol. 2018:1-7. doi:10.1111/jdv.14857.
43. Cowen A, Yosipovitch G. Pharmacology of Itch. Vol 226.; 2015. doi:10.1007/978-3-662-44605-8_7.
44. Gooding SMD, Canter PH, Coelho HF, Boddy K, Ernst E. Systematic review of topical capsaicin in the treatment of pruritus. Int J Dermatol. 2010;49:858-865. doi:10.1111/j.1365-4632.2010.04537.x.
45. Anand S. Gabapentin for Pruritus in Palliative care. Am J Hosp Palliat Med. 2013;30(2):192-196. doi:10.1177/1049909112445464.
46. Cohen AD, Masalha R, Medvedovsky E, Vardy DA. Brachioradial pruritus: A symptom of neuropathy. J Am Acad Dermatol. 2003;48(6):825-828. doi:10.1067/mjd.2003.494.
47. Yosipovitch G, Samuel LS. Neuropathic and psychogenic itch. Dermatol Ther. 2008;21:32-41. doi:10.1111/j.1529-8019.2008.00167.x.
48. He A, Alhariri JM, Sweren RJ, Kwatra MM, Kwatra SG. Aprepitant for the Treatment of Chronic Refractory Pruritus. Biomed Res Int. 2017;2017:1-6. doi:10.1155/2017/4790810.
49. Skelton F, Frontera J. Brachioradial Pruritus as a Harbinger of Syrinx in Chronic Spinal Cord Injury: A Case Report. PM R. 2017;9:311-313. doi:10.1016/j.pmrj.2016.08.005.
50. Dhand A, Aminoff MJ. The neurology of itch. Brain. 2014;137:313-322. doi:10.1093/brain/awt158.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Creative Commons Attribution (CC BY): lets others distribute and copy the article, to create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), to include in a collective work (such as an anthology), to text or data mine the article, even for commercial purposes, as long as they credit the author(s), do not represent the author as endorsing their adaptation of the article, and do not modify the article in such a way as to damage the author's honor or reputation.
Authors retain copyright in their work and license the publisher to publish the content. The publisher is the National Society for Cutaneous Medicine, with production and publishing support provided by OJS, Open Journal Systems,see https://pkp.sfu.
Prior to January 2022, authors transferred copyright to the National Society for Cutaneous Medicine. However, all articles are freely available to anyone in the world. There are no subscription fees, page charges, or article processing charges.