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Brachioradial Pruritus


Presentation

  • BRP patients may present to neurology; however, there is little regarding this condition in the neurology literature.[n.neurology.org]
  • The author presents two patients suffering from brachioradial pruritus who were treated with thalidomide and presented excellent results. This paper aims to suggest a new therapeutic option for this refractory disease.[scielo.br]
  • Neuropathic pruritus can present clinically as brachioradial pruritus or notalgia paresthetica. Showing page 1. Found 4 sentences matching phrase "Brachioradial pruritus".Found in 1 ms.[glosbe.com]
  • It can either involve only one side of the body or present bilaterally.[onlinelibrary.wiley.com]
  • Discussion This case presents a rare chronic sensory neuropathy which is poorly understood.[cureus.com]
Asymptomatic
  • Degenerative cervical spinal changes are found in 70% of asymptomatic women and 95% of asymptomatic men older than 65 years [29] ; thus, without age-matched controls, implicating cervical spinal disease as the cause of brachioradial pruritus is erroneous[emedicine.medscape.com]
  • The treatment was prescribed for 60 days, and 30 days after discontinuation both patients continued asymptomatic.[scielo.br]
  • The patient also experienced a period of several consecutive days during week 5 where she was asymptomatic as well. Examination during the five-week office follow-up showed resolution of the excoriations on her arm (Figure 4 ).[cureus.com]
Enuresis
  • It is also used to treat other conditions inclusive of pain syndromes, enuresis, and insomnia [10] . Its activity is thought to relate to its inhibition of 5-HT and norepinephrine reuptake.[cureus.com]
Photosensitivity
  • Thalidomide has been very useful to treat photosensitive diseases, such as discoid lupus erythematous, light polymorphic eruption, 8 and particularly actinic prurigo. 10 Since there is no specific medication and both patients were menopaused, thalidomide[scielo.br]
  • ‘BRP is at least in part a photosensitivity disorder' Marziniak 2011 9 ( n 41) Male: 13 (32).[onlinelibrary.wiley.com]
Cutaneous Manifestation
  • Cutaneous manifestations in neuro-oncology: clinically relevant tumor and treatment associated dermatologic findings. Semin. Oncol. 2016 Jun; 43 (3):401-7. [ PubMed : 27178695 ] 9. Salako KB, Anstey AA, Logan RA.[ncbi.nlm.nih.gov]
Osteophyte
  • Epidural cervical steroid injections at the C6-7 level were reported to lead to disappearance of itch in a patient with brachioradial pruritus. [13] Cervical spine tumors, [25] cervical ribs, hypertrophic cervical transverse processes, [26] and cervical osteophytes[emedicine.medscape.com]
  • Magnetic resonance imaging of her cervical spine revealed a left-sided osteophyte causing minimal left neural foraminal stenosis at the level of C3 to C4 (Figure).[mdedge.com]
Fracture
  • During the initial assessment of patients with brachioradial pruritus (BRP) and Notalgia paresthetica, it is important to obtain a thorough past history of osteoarthritis, prior neck trauma, motor vehicle accident, vertebral fracture, cervical neoplasm[lagunaskincenter.com]
Dysesthesia
  • There are multiple types of dysesthesias depending on the body location and the nerves involved.[read.qxmd.com]
  • Additional features of the dermatologic condition may include localized burning, pain, tenderness, hyperalgesia, or dysesthesias. BRP tends to be a chronic condition with periodic remissions and exacerbations.[lagunaskincenter.com]
  • Introduction Brachioradial pruritus (BRP) is a localized neuropathic dysesthesia of the dorsolateral upper extremities. It is commonly seen in middle-aged white females with a seasonal predilection for warmer summer months.[ncbi.nlm.nih.gov]
Trigeminal Neuralgia
  • Botulinum toxin and intractable trigeminal neuralgia. Clin Neuropharmacol 2005;28:161-2. 23. Szepietowski JC Wąsik G Notalgia paresthetica: a rare manifestation of localized pruritus. Przegl Dermatol 2002;89:215-7.[content.sciendo.com]

Workup

  • Further workup, such as imaging, labs, and referral to specialists is rarely required. Therapeutic options are numerous and well-tolerated.[ncbi.nlm.nih.gov]
  • And you should never just dismiss a very persistent symptom—even if it seems like no big deal—without a proper workup. Below are some reasons you may be feeling itchy, even when there is no rash present. 1.[self.com]
Cervical Spine X-Ray
  • Expected results of diagnostic studies Routine cervical spine X-rays are advisable to check for structural lesions. Cervical magnetic resonance imaging should be performed if the onset is recent or neurologic deficits are present.[dermatologyadvisor.com]

Treatment

  • Bueller HA, Bernhard JD, Dubroff LM: Gabapentin treatment for brachioradial pruritus. J Eur Acad Dermatol Venereol. 1999, 13:227-228. Winhoven SM, Coulson IH, Bottomley WW: Brachioradial pruritus: response to treatment with gabapentin.[cureus.com]
  • Other treatments of neuropathic pain and itching, including capsaicin, amitriptyline, and gabapentin, can sometimes be successful. 5, 12, 13 Many patients are refractory to multiple treatments.[ncbi.nlm.nih.gov]
  • Cutaneous Field Stimulation in the Treatment of Severe Itch. Arch Dermatol. 2001;137:1232-1325. doi:10.1001/archderm.137.10.1323. Stellon A. Neurogenic pruritus: An unrecognised problem? A retrospective case series of treatment by acupuncture.[jofskin.org]
  • Mean inpatient treatment costs were reduced by 212.31, and mean outpatient treatment and medication costs by 100.74 per patient (p.p.).[tripdatabase.com]
  • Once the causative condition is identified, a variety of treatments are available, depending on diagnosis.[ozarkderm.com]

Prognosis

  • What is the prognosis (outlook) for itching? Itching itself is not associated with long-term skin problems or harm, and most cases of itch are temporary and resolve on their own or with topical or oral treatments.[medicinenet.com]

Etiology

  • Often described as dermatologic syndromes, both diseases are typically considered to be multifactorial in etiology with an uncertain etiology...[read.qxmd.com]
  • History and Physical Because pruritus has many etiologies, a thorough history is essential to avoid unnecessary testing and delay in treatment.[ncbi.nlm.nih.gov]
  • Aimee Szewka, Michael Gibbs, Jonathan Cheponis, Steven Lewis First published April 4, 2016, Abstract OBJECTIVE: To report three cases of brachioradial pruritus (BRP), describe the typical clinical presentation and epidemiology, and discuss possible etiology[n.neurology.org]
  • It is likely that the etiology of BRP is not uniform and both of the above factors contribute to varying degrees in different patients.[dermatologyadvisor.com]
  • Some of the current systemic therapies may in fact exert their effect through the spinal nerves and central nervous system thereby supporting the neuropathic etiology of BRP( Brachioradial Pruritus).[lagunaskincenter.com]

Epidemiology

  • ; 86 (16 Supplement) April 18, 2016 Aimee Szewka, Michael Gibbs, Jonathan Cheponis, Steven Lewis First published April 4, 2016, Abstract OBJECTIVE: To report three cases of brachioradial pruritus (BRP), describe the typical clinical presentation and epidemiology[n.neurology.org]
  • The emergence of brachioradial pruritus cases in temperate climates has further contributed to research efforts to discover more about the epidemiology of this neurocutaneous condition.[wisegeek.com]
  • Epidemiology Early isolated case reports suggested that brachioradial pruritus was more common in males. Later larger studies revealed that brachioradial pruritus is seen more commonly in females than males in a ratio 3:1.[ncbi.nlm.nih.gov]
  • Epidemiology Affects Caucasians living in tropical regions More common in middle-aged women III. Pathophysiology: Postulated Mechanisms with nerve compression Prolonged ultraviolet light exposure (e.g. tropics) IV.[tripdatabase.com]
  • 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. Mirzoyev SA, Davis MDP.[jofskin.org]
Sex distribution
Age distribution

Pathophysiology

  • In view of the literature, a definitive pathophysiology for brachioradial pruritus does not exist. It is clear that it is a unique clinical entity, but the pathophysiologic basis is not known.[mdedge.com]
  • […] supporting the solar hypothesis Many patients with brachioradial pruritus have a history of chronic sun exposure. [2, 14, 15] Kestenbaum and Kalivas [16] postulated that histamine release from mast cells in response to chronic sun exposure might play a pathophysiologic[emedicine.medscape.com]
  • Pathophysiology: Postulated Mechanisms with nerve compression Prolonged ultraviolet light exposure (e.g. tropics) IV.[tripdatabase.com]
  • Recent advances in pathophysiology and current management of itch. Ann Acad Med Singapore 2007;36:788-92 7. Wallengren J. Brachioradial pruritus: a recurrent solar dermopathy. J Am Acad Dermatol 1998;39:803-6. 8. Wallengren J Sundler F.[content.sciendo.com]
  • The lack of primary skin lesions in brachioradial pruritus in addition to its poorly established pathophysiology can often lead to both diagnostic and therapeutic challenges for many physicians.[read.qxmd.com]

Prevention

  • Prevent the condition from worsening In Australia, most cases result from sun damage to sensory nerves and sun protection to prevent summertime worsening is important.[dermcoll.edu.au]
  • […] initially diagnosed on the appearance of symptoms, but other testing is required to determine the causative factor, including radiological, imaging, nerve testing, and Skin biopsy Treatment *Treatment is not always successful *Goal of treatment is to prevent[ozarkderm.com]
  • Targeting these damaged nociceptors and preventing them from firing can potentially lead to symptomatic improvement.[cureus.com]
  • Brachioradial Pruritus Brachioradial Pruritus Brachioradial Pruritus Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention[tripdatabase.com]
  • The best way to prevent pruritus is to take care of your skin. To protect skin: Use skin creams and lotions that moisturize your skin and prevent dryness. Use sunscreens regularly to prevent sunburns and skin damage.[webmd.com]

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