Brachioradial Pruritus and Notalgia Paraesthetica: A Comparative Observational Study of Clinical Presentation and Morphological Pathologies

Abstract

Brachioradial pruritus (BRP) and notalgia paraesthetica (NP) represent 2 of the most common neuropathic itch syndromes. A total of 58 consecutive patients presenting at the Center for Chronic Pruritus, University Hospital Münster, were analysed with regard to clinical presentation, anatomical and morphological pathologies, impairment in quality of life, and response to treatment with topical capsaicin. Patients with BRP reported stinging and burning more often than those with NP. In the BRP group structural magnetic resonance imaging abnormalities more frequently correlated with localization of the symptoms compared with in patients with NP. In addition, intraepidermal nerve fibre density was decreased in lesional skin in patients with BRP, but not in those with NP, confirming the neuropathic origin in BRP. Topical capsaicin resulted in a significantly higher alleviation of itch and pain intensity and improvement in quality of life in patients with BRP compared with those with NP, which may reflect clinical and aetiological differences between the conditions.

Treatment of Brachioradial Pruritus: A Systematic Review

“…17,9,11 While 27% of patients require another patch applied at three months, and 13.7% another at six months, all patients noted a significant improvement in QOL. 9,11 Side effects include intense burning, which can be mitigated by pre-treatment with topical lidocaine. 17 Other topicals studied for BRP include amitriptyline 1%/ketamine 0.5% cream, topical steroids, doxepin cream and local anesthetics.…”

“…Two prospective cohort studies and one case series (n=30), have reported on its effective use in BRP after one hour of application. 9,11,17 One study described an 85% reduction in itch as soon as three weeks post-treatment and lasting three months, while two others reported a statistically significant decrease in pruritus six months after treatment . 17,9,11 While 27% of patients require another patch applied at three months, and 13.7% another at six months, all patients noted a significant improvement in QOL.…”

“…9,11,17 One study described an 85% reduction in itch as soon as three weeks post-treatment and lasting three months, while two others reported a statistically significant decrease in pruritus six months after treatment . 17,9,11 While 27% of patients require another patch applied at three months, and 13.7% another at six months, all patients noted a significant improvement in QOL. 9,11 Side effects include intense burning, which can be mitigated by pre-treatment with topical lidocaine.…”

“…After removing duplicate data (Pinto et al/Waccholz et al and Pereira et al/Stienke et al), 399 patients with BRP were included. 4,[9][10][11] Given that most data on BRP treatment comes from case series and reports, the overall quality of the evidence reviewed is low (Table 1-4).…”

Itchy body: Topographical difference of itch and scratching and C Nerve fibres

“…There has been a school of thought that an increase of intraepidermal nerve fibres (IENF) is a cause of itch while decrease in IENF improve itch . However our and other groups’ extensive studies in imaging of nerve fibres in skins of humans in dermatoses, such as atopic dermatitis, nummular eczema, psoriasis, cutaneous T cell lymphoma, lichen amyloidosis, prurigo nodularis, stasis dermatitis, and brachioradial pruritus, demonstrated the opposite (Table ): in those patients with chronic itch, a decrease in IENF is noted compared with healthy controls, which normalizes when itch is treated and improved. Pogatzki‐Zahn et al recently demonstrated that, in addition to decreased IENF, a mixed peripheral and central pattern of neuronal alterations was observed in patients with atopic dermatitis, brachioradial pruritus, and prurigo nodularis and might contribute to the chronicity of pruritus in these dermatoses.…”