What is the treatment for brachial pruritus?

Treatment for Brachial Pruritus

For brachial pruritus, the recommended first-line treatment is gabapentin (starting at 900 mg/day), as it has shown good efficacy in controlling this specific type of neuropathic itch. 1, 2

Diagnosis and Evaluation

Before initiating treatment, consider these important diagnostic factors:

• Evaluate for cervical spine injuries, as these are commonly associated with brachioradial pruritus 1
• Check for possible triggers such as:
  • Sun exposure/ultraviolet radiation (common exacerbating factor) 3
  • Cervical disc herniation or degenerative changes 1, 3
• Rule out contact dermatitis from external agents 4

Treatment Algorithm

First-line Treatment

1. Gabapentin therapy
   • Start at 900 mg/day 1
   • Titrate dose based on response and side effects
   • Has shown encouraging results specifically for brachioradial pruritus 2

Second-line/Adjunctive Treatments

1. Topical treatments
   • Capsaicin cream
     • Apply a thin film to affected area 3-4 times daily 5
     • Wash hands thoroughly after application
   • Emollients with high lipid content 4
   • Topical corticosteroids (if inflammation present)
     • Hydrocortisone: apply to affected area 3-4 times daily 6
     • Use low-potency formulations to avoid skin atrophy 4

For Refractory Cases

1. Alternative medications
   • Pregabalin (25-150 mg daily) 4
   • Amitriptyline (has shown relief in some patients) 7
   • Mirtazapine (30 mg daily) 4
   • Selective serotonin reuptake inhibitors 4

Important Considerations

• Standard antihistamines and corticosteroids are often ineffective for brachioradial pruritus 1
• Diagnosis is frequently delayed (2-3 years on average), leading to unnecessary testing and treatments 3
• All patients with brachioradial pruritus should be evaluated for cervical spine injuries 1
• Sun protection is important for patients who report exacerbation with UV exposure 7

Patient Education

• Advise patients on:
  • Avoiding sun exposure if it triggers symptoms
  • Regular application of prescribed treatments
  • The neuropathic nature of the condition (not a primary skin disorder)
  • The need for cervical spine evaluation
  • Potential long-term management requirements

Follow-up

• Reassess after 2 weeks of treatment
• If improved, continue treatment until resolution
• If no improvement, consider increasing gabapentin dose or adding second-line agents
• For persistent cases, consider referral to neurology or pain management

Brachioradial pruritus is a distinct neuropathic condition that requires specific treatment approaches different from typical pruritus management. Recognition of its association with cervical spine pathology is crucial for proper management.