Brachioradial pruritus: Mayo Clinic experience over the past decade

Abstract

SummaryBackground Brachioradial pruritus (BRP) is a fascinating condition that is seen increasingly often, but any additional data from retrospective observational studies can still enhance our understanding. Objectives To review our experience at the Mayo Clinic with patients presenting with BRP. Methods We retrospectively reviewed the clinical records of patients diagnosed with BRP between 1999 and 2011. Results In total, 111 patients (80 female, 72%) had been diagnosed with BRP. Their mean age was 59 years, range 12-84 years. Symptoms were bilateral in 84 (75Á7%). Fifty-four patients (48Á6%) reported prolonged exposure to the sun, and 16 had a history of neck concerns. Forty-five (40Á5%) had undergone imaging studies of the neck; of these, eight had foraminal stenosis, six had protrusion of the intervertebral disk and six had stenosis of the spinal canal; 10 had more than one cervical abnormality. Thirty-one patients had been referred to neurology; eight of these had BRP attributed to a radiculopathy or peripheral neuropathy. Several topical and oral medications were prescribed. Seventy-five patients had a follow-up; of these, nine (12%) had complete resolution, 13 (17%) had improvement, four (5%) showed no change and 49 (65%) had no mention of BRP. Conclusions Brachioradial pruritus presented most commonly in female patients and was observed over a wide age range. Although a third of patients with imaging studies had cervical abnormalities, the significance of these findings is unclear, as no structural causes of BRP were found in most cases. Some treatments were more successful than others.

Impact of drug therapy on brachioradial pruritus

“…Adult outpatients with BRP, diagnosed using valid criteria, 1,3 were included in a cross-sectional study from May 2011–2014. Clinical and treatment information were recovered from medical records.…”

Clinical, epidemiological and therapeutic profile of patients with brachioradial pruritus in a reference service in dermatology

“…1,2,3 This condition is polymorphic, with itching, burning, stinging, or tingling sensations, particularly in the topography of the brachioradialis muscle (BRm), unilaterally or bilaterally. 4,5,6 Occasionally, it extends to the upper arms, shoulders, back, and cervical region or upper thorax. 4 The insidious clinical course, late diagnosis and poor or absent response to antihistamines and corticosteroids are associated with a significant impairment in the quality of life.…”

“…4 The insidious clinical course, late diagnosis and poor or absent response to antihistamines and corticosteroids are associated with a significant impairment in the quality of life. 1,4 Most publications involving BRP are case reports or case series 4,5,6 and there is no standardization in the assessment of disease severity, impact and activity that allows direct comparison between studies. More comprehensive descriptions of BRP clinical presentation and response to treatment, with respect to the intensity of symptoms and therapeutic response, are gaps in the medical literature.…”

“…Worsening factors, such as touch, sun exposure, the act of scratching and seasonality - have been reported in other case series. 2,4,5,6 …”

“…5,6 TCAs, antipsychotics and anticonvulsants are central modulators of pruritus. 9 This study suggests that these drugs may be effective in BRP, reducing symptoms, as well as recurrences.…”