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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
Article Sources
1) Brachioradial Pruritus. Medscape. Retrieved August 13, 2016.
http://emedicine.medscape.com/article/1355312-overview
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.
http://www.degruyter.com/downloadpdf/j/sjdv.2009.1.issue-2/v10249-011-0006-z/v10249-011-0006-z.xml
3) Thoughts about brachioradial pruritus. The Online Journal of Community and Person-Centered Dermatology (OJCPCD). Retrieved August 13, 2016.
http://ojcpcd.com/elpern-d-j/thoughts-about-brachioradial-pruritus
Add a Comment130 Comments
I experienced this beginning in July of 2014. I itched for 18 months before finding this article/site. It was such a relief to know I wasnt crazy. I already used laundry products with no dye or perfume, I went on a 17 day fast to eliminate possible food related allergies (no change), I changed my shampoo, body soap, deodorant, I stopped wearing perfume. Years ago I began to only wear cotton, silk or rayon. I went to the dermatologist, allergist, chiropractor, acupuncturist, voodoo priest (okay I made that one up), and finally a new general MD (I am new to this area and needed a new Dr anyway)
In my case, this is 100% because of my neck. So I am firmly in the camp that believes this to be a compression of the 6th cervical vertebrae. My new Dr made me a compound cream of Gabapentin, lidocaine, and a few other ingredients, sent me to physical therapy for 8 weeks and I was cured! I have never been so happy or grateful. It lasted A blissful 4 months. Then I went to Germany on a work trip, and while the bed was comfortable the pillows were horrible. On the return trip home I started to itch again, this time at my elbows. This has been almost 2 months now. I'm on my way in an hour back to my chiropractor and physical therapy. I pick up my new compound cream after PT. SIGH.
So the moral of my story is that I need to take my pillow with me wherever I go. I am a side sleeper and have a pillow for that.
I just know that this was coming from inside me (my brain, literally), and had nothing to do with my skin. Ice packs are the only real relief when the nerve endings are firing. I do live in a sunny climate, but my itching has never changed because of season or exposure.
Hopefully now that I know what to do, once this has resolved (again), I can be itch free forever!
I wish that for all of you, too!!!
August 29, 2016 - 7:30amThis Comment
Hi, I live in Perth Western Australia. The summers here are unforgivingly hot - our sun here literally burns steel! I never had this itching problem before. My wife and I contracted it at the same time about 3 months ago - on our forearms in the elbow region. Coincidentally we both developed a sore elbow joint - like an arthritis attack. My itch spread to the stomach about 4 inches away from my belly button. I tried various creams, ie Dettol etc from the supermarket and chemist with moderate results. I used a cut lemon and rubbed it over the itchy areas and it helped somewhat. I even used Listerine mouth wash and that gave me some relief. If it is the sun, then why not the rest of the body and long time ago? I have a bad neck (arthritis in joints) and broken back with concussed spine but that occurred years ago and why flare up now? It's winter here and I only started to get this itchy condition at the start of winter. We use an electric blanket, sleep on a rubber/latex mattress and use Duve's purchased from Ikea. My theory is it's an allergy condition of sorts. Perhaps the rubber/latex mattress is undergoing hysteresis (ie rubber/latex compounds slowly breaking down via the heat from the electric blanket). But why just the arms? Does anyone else with this condition sleep on rubber/latex mattresses or mattresses with memory foam? It could be the culprit as my wife and I have not altered our food, perfumes, detergents etc in recent times. I'll go and see my doctor if he can put an angle on it. One thing for sure is that I'm allergic to the band aid called Elastoplast which is made of a latex cloth fabric having a strong adhesive. My doctor put a patch on me about 2 years ago when I went for a checkup and gave a blood sample. The area on my arm where the Elastoplast band aid was applied went red and remained very itchy for over 6 months and took about 12 months to disappear! Could there be a connection - an allergy to rubber/latex materials?
August 25, 2016 - 6:34amThis Comment
HI, I'm also in Perth and seeking more information / treatment for this condition. Have you any updates? Thanks!
January 4, 2017 - 8:01pmThis Comment
I've also begun to believe it's allergy related. Mine has been going on for years. But, it only occurs on my arms. Different areas of my arms at different times. I've finally realized it only happens to me in the Fall. Beginning in late August & running through late November. I live in in the southern state of Georgia in the United States. I feel it may be something that blooms here this time of year. That is also the time of year that is worst for my sinus allergies.
When I first saw my Dermotilogist about this she had no clue. There is no rash on my skin. There is nothing but the awful itch. I really think she thought it was all in my head. I followed her advice of no perfumed lotions & dye free/fragrance free laundry detergent. But, the itching still occurs every Fall. I use ice packs to numb it & that helps stop it temporarily.
August 25, 2016 - 2:00pmThis Comment
Hi again,
August 26, 2016 - 6:40amI have read most of the reports published on this site and one common thread I noticed is that most itchy attacks occur in autumn and leading into winter. It seems not many attacks occur in summer and that should tell us something - ie there is a positive correlation between lack of heat and/or sunlight and increased attack of itchiness. Is it a Vitamin D deficiency? Some doctor or expert should investigate this correlation. Secondly, yes after winter sinus aggravation is caused by all the new seeds and pollen in the air. However I don't think sinus problems cause itchiness on the forearms and elbow regions. It is too localized. Do you sleep on a latex/rubber mattress or foam mattress and use an electric blanket to pre-heat the bed in winter months? That is the only difference in our household that changed in recent months and both my wife and I contracted itchy arms at the same time (mine worse than hers). Neither of us have experienced this problem before. This is too much of a coincidence to say the least. Initially I thought it was insect bites such as Kangaroo ticks or pepper ticks. I've been bitten by them before and they cause severe itching and take many months to go away. The red itchy areas can recur again years later in the same spots if bitten again by another tick. They have a nasty virus they inject into your body that can remain for a very long time. Hmm - I'm bewildered. Are you bushwalking or hiking in the countryside in forests and tall grasses where ticks are prevalent?
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The answer to both questions is no. I don't use a latex mattress cover or electric heated blanket. Nor do I hike. I'm not very outdoorsy. Haha!
August 26, 2016 - 12:03pmBack to the drawing board I guess.
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I have been suffering from my arms itching for over 10 years, it gets so painful to be honest it feels like bugs or sometimes bee's stinging and biting me from the inside of my arms :( the only thing that helps to calm it down is having my arms packed down with ice and usually it is at night time, if I am exposed to sunlight my skin will sometimes Crack open and bleed, also if I get my nerves so rattled up the itching becomes intense, I have been to many hospitals saw many many different doctors and dermatologists, I also saw neurologist that have claimed that this is all in my head :( I have had many different creams prescribed that never had no effect on my problem. I have had biopsy on my arms I have been tested for many things and there have never been any answers to why this is happening. July 1st , 2006 my daughter took me to the tanning bed Salon because I was getting married in one week the lady said she would set the timer for 5 minutes because I have very very fine skin well I went into the tanning room late on the tanning bed the fan was on music was playing and I kind of fell asleep the lady in the front was on the phone with someone for all that time she had forgotten to set the timer I must have laid back there for over 30 minutes it took me 2 months to not look like a lobster anymore one week after the tanning bed or deal and I've got married I began to start its in my arms severely at night every night it was the same thing then I decided to put some cold ice on it and once a month my arms the pain was gone but if I was to lay in bed and put the covers on one and get too hot the same thing happened again I needed to get up and get ice it has been over 10 years now and I am still suffering with the same problem having to put ice on my arms every night I can not go to the beach and enjoy a fun time with my kids or grandkids I am limited when it comes to going outside and being in the sun I wish that I could find a doctor that can prescribe something to help me so I will be able to enjoy life again and go outside with the kids I just felt like I needed to share my story I am so tired of living this way please God let them find a way to come up with a solution for my problem... Christine
August 22, 2016 - 1:54pmThis Comment
Hi there!
September 9, 2016 - 11:08pmOmg I feel like I'm going mad!!!! I've had this itching for 4 yrs and its at its worst! I'm awake every night at least once with my arms going crazy like they are alive and with millions of crawlies until the skin then it starts pinching and nipping and I end up bruising and cutting my skin from squeezing and scratching skin. ....ice packs have been my saviour but it's not lasting relief anymore! I had to stop to scratch between every 3 letters of this text! Help!
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I knew I couldn't be the only one with this problem! I thought it was the dry California air, but noticed it flares up after hours of weed Wacking and grass cutting in spring and summer. My arms get a lot of sun during these months and I've tried Quatroderm and moisturizing lotions with not much relief. Will try the lime juice and coconut oil infused with cannibis oil. The Kwan Loong oil seems to be working. I just put some on after reading that it might work. The burn is a welcome relief to the itch!
August 5, 2016 - 3:32amThis Comment
I'm so relieved to have found this article. I live in England but two years ago changed my lifestyle and now spend much of the winter in sunny South Africa. This itching is a new phenomenon for me. The first attack was in South Africa and I thought it must be insect bites but how could it be without any physical evidence? The itching affects the elbow end of the forearm and sometimes it feels like tiny needles are piercing the skin. I had another attack in South Africa this last winter and a few days ago, here in England's summer, it flared up again hence my search for an explanation. I haven't had back or neck problems but I do have the red hair gene that makes my skin more susceptible to sun damage. No one else has mentioned this but I do wonder if it's a factor. But why just the forearms? That makes no sense. My shoulders get more sun. I shall try all the solutions mentioned and try to resist scratching!
July 29, 2016 - 1:14amThis Comment