Alerts and Notices
SynopsisBrachioradial pruritus (BRP), first described as solar pruritus of the elbows (brachioradial summer pruritus), is a chronic recurrent dysesthesia marked by a burning and tingling pruritic sensation. It is commonly localized to the dorsal lateral proximal forearm area, although in some cases, it may spread to involve the more proximal upper arm, shoulder, lower neck, and even the contiguous chest or upper back. It may be unilateral, affecting either arm, but is frequently bilateral. There are no primary lesions, but secondary changes from scratching are often observed.
BRP is a condition of middle age with onset most commonly between 40 and 60 years of age, although cases have been reported as early as adolescence. It tends to affect women more frequently than men, and symptoms are noted to exacerbate in spring and summer in temperate climates.
The underlying cause of BRP is thought to be the result of some perturbation to the cervical nerve roots, specifically a degree of compression of roots in the C3-C7 area, as well as ultraviolet damage, both chronic and acute, to epidermal and dermal nerve fibers.
L29.8 – Other pruritus
402178001 – Brachioradial pruritus
Differential Diagnosis & Pitfalls
- Zoster sin herpete – Unusual presentation of herpes zoster where dermatomal pain is present without cutaneous rash. Usually presents with unilateral pain, with BRP often presenting bilaterally.
- Notalgia paresthetica – Usually presents with a well-circumscribed, hyperpigmented patch on the back that may be pruritic and/or painful.
- Neurotic excoriations – Itching and markings of excoriations are typically found in accessible areas, and are usually present on multiple areas of the body.
- Xerosis (dry skin) – Typically presents with fine scale and accentuated skin markings.
- Lichen simplex chronicus – One or more well-demarcated, lichenified plaques with exaggerated skin lines are found on any location that the patient can reach.
- Prurigo nodularis – Usually presents with multiple discrete, scaly nodules or papules on the extensor surface of the arms and legs.