Neuropathic itch (itching or pruritus) arises from a pathology located at any point along the afferent pathway of the nervous system. It may be related to damage to the peripheral nervous system, such as in postherpetic neuropathy, brachioradial pruritus or notalgia paresthetica. It has many clinical features similar to neuropathic pain. Patients complain of itching, which is associated with burning sensation, aching, and stinging. Brachioradial pruritis (BP) is an intense itching sensation of the arm, usually between the shoulder and elbow of one or both arms. It is an enigmatic condition with a controversial etiology; some authors consider BP to be a photodermatosis, whereas other authors attribute BP to compression of cervical nerve roots. Notalgia paresthetica is an isolated mononeuropathy involving the skin over or near the scapula. Patients have a pruritus on the mid-upper back. The treatment is usually difficult, but capsaicin and local analgesic agents are the options of choice. Brachioradial pruritus and notalgia paresthetica are often unrecognized neurocutaneous conditions and therefore, a thorough history and physical examination are of utmost importance to distinguish symptoms and apply accurate therapeutic options.
1. Karnath BM. Pruritus: a sign of underlying disease. Hosp Physician 2005;41(10):25-9.
2. Twycross R, Greaves MW, Handwerker H, Jones EA, Libretto SE, Szepietowski JC, et al. Itch: scratching more than surface. Q J Med 2003;96:7-26.
3. Stander S, Weisshaar E, Mettang T, Szepietowski JC, Carstens E, Ikoma A, et al. Clinical classification of itch: a position paper of the International Forum for the Study of Itch. Acta Derm Venereol 2007;87:291-4.
4. Yosipovitch G, Samuel SL. Neuropathic and psychogenic itch. Dermatol Ther 2008;21:32-41.
5. Ikoma A, Rukwied R, Stander S, Steinhoff M, Miyachi Y, Schmelz M. Neurophysiology of pruritus: interaction of itch and pain. Arch Dermatol 2003;139:1475-8.
6. Greaves MW. 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. Brachioradial pruritus is associated with a reduction in cutaneous innervation that normalizes during the symptom-free remissions. J Am Acad Dermatol 2005;52:142-5.
9. Cohen AD, Masalha R, Medvedovsky E, Vardy DA. Brachioradial pruritus: a symptom of neuropathy. J Am Acad Dermatol 2003;48:825-8.
10. Waisman M. Solar pruritus of the elbows (Brachioradial summer pruritus). Arch Dermatol 1968;98:481-5.