Brachioradial pruritus L29.9

Waisman 1968

Chronic (>6 weeks persistent = definition of chronic itching), mainly on the extensor forearms localized, mostly bilateral neuropathic itching (possibly combined with paresthesia).

Degenerative changes of the cervical spine (C5-C8) are the main cause.

In about 30% of the patients, nerve compressions due to intervertebral disc protusions or stenoses of the foramina were detected.

Prolonged UV exposure may be an additional trigger factor.

Mean age at first onset of itching 59J (12-84 years); in men the age is slightly higher at 60.5 years; w:m=8:2 (Masuda PY et al. 2013);

The extremities are affected, especially the hands and feet as well as the extensor sides of the forearms (and lower legs).

Chronic, mostly bilateral (75%), very unpleasant, rather stinging, predominantly intermittent, rarely continuous itching, which is answered by the affected persons with rubbing (not scratching or pinching).

Often seasonally increased, especially in the summer months after prolonged UV-irradiation (in larger collectives in about 50% of those affected).

No visible changes of the skin (see Notalgia paresthetica).

A diagnostically valuable sign is the "ice pack sign", a clear alleviation of itching under cold application.

Arterial hypertension and depression are reported as comorbidities.

The most common radiological changes affect the spine (C4-C5, C7/T1): stenosis of the intervertebral spaces (about 75% of those affected) and osteophytosis (about 60%) have been shown.

The histological picture is not conclusive. Apart from actinic elastosis, the findings are "normal". Experimental: Reduction of the intraepidermal nerve fibers, especially those sensitive to calcitonin.

Treatment of the causing spinal nerve compression.

Moderate success (about 30% of patients respond) has been reported with administration of gabapentin or carbamazepine (alternative: lamotrigine).

• Gabapentin: Adults: dosage within 3 days (day 1: once/day 300 mg p.o., day 2: twice/day 300 mg, day 3: three times/day 300 mg p.o.). Alternatively: initial dose 900 mg/day in 3 equal ED, maximum total dose: 3600 mg.
• Carbamazepine: Adults: General daily dosage range: 400-1200 mg. Total daily dose of 1600 mg should not be exceeded. Therapeutic carbamazepine levels: experience shows between 4 and 12 μg/ml.

Successes are achieved with capsaicin ointment(e.g. dolenone, capsamol) over a treatment period of several months. Application of capsaicin is unpleasant due to burning, itching etc. in the first days (inform the patient!). Improvement can also be achieved with local anaesthetic creams (e.g. EMLA cream). Treatments with Physiogel AI cream or antipruriginous substances such as camphor or menthol (e.g. menthol solution as a prescription or Pruricalm as a ready-to-use drug) can be tried.

Clarification of degenerative spinal column changes by CT or MRT.

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