There are many causes of itch-ing: allergies, eczema, psoriasis, chicken pox, measles. However, in all of these you can usually see a rash, red skin, lumps or something causing the itch. In the case of an insect bite, you will see the mark. In the case of neuropathic itch there are no marks on the skin, no lumps, no spots. Usually, the only sign is the redness of the skin after the constant itching causes scratching. This sometimes leads to bleeding in the case of frantic scratching of the skin.
This condition can take place anywhere on the body. However, it is usually only in one place, which leads the medical team to realise that it isn’t an allergy. I am going to look at itching arms today, known as brachioradial pruritus. This is a condition where itch, burning, stinging, tingling and/or a changed sensation arises in the areas of skin on either, or both, arms.
The most commonly affected area is the mid-arm, however, forearms and upper arms can also be affected. Sufferers often apply ice packs to the affected areas in an attempt to gain relief from the unbearable symptoms. They are usually worse at night.
The affected skin may appear entirely normal. As I mentioned before, the only changes are from rubbing and scratching the area. Also, when regularly applying ice pack for relief, the skin can become harder, less soft in comparison to the other arm. Brachioradial pruritus can occasionally extend to include lower legs or generalises to other sites in the body.
The cause of this condition is due to the neuropathy of the small C fibre nerves. This helps us understand that the sensations are under the skin and not on the skin. The feeling is of small pin pricks, or the sensation of a feather being swept across the skin, in some cases they increase to give a burning sensation. All of these sensations are constant, they never cease.
Brachioradial pruritus appears to be more often reported in sunny climates than in cooler areas, which leads to the conclusion that long-term sun exposure could cause damage to the nerve fibres within the skin.
Sufferers often apply ice packs to the affected areas in an attempt to gain relief
However, the cause I want to concentrate on is due to the nerve damage or radiculopathy in the cervical spine (the neck). It can be due to cervical vertebral osteoarthritis, cervical rib, cervical spinal tumour or nerve compression or myelopathy for any other reason.The example I can offer is that of experiencing whiplash during a car accident which seriously affected the cervical spine. This caused compression of the cervical nerves in the neck, the sixth cervical vertebrae, in some cases the seventh.
Prolonged compression of spinal itch-transmitting neurones can activate central sensitisation processes, affecting the A fibres. These convey light touch and pinprick symptoms, the stimulation can result in sensitive or painful skin with exaggerated response to light touch or pin pricks (hyperaesthesia, hyperalgesia).
This condition has the shortened name of neuropathic itch. Some physicians will recommend antihistamine in the hope it is an allergy-related condition. In the long term, treatment is not always successful. There are several medications including topical creams. Topical anaesthetics, such as lidocaine, will desensitise the sensory nerves, or numb the area. This, of course, is short term and during the night the sufferer will wake up, perhaps three times to re-apply the cream as the itching returns and they begin to scratch in their sleep.
Ice packs can be used during the night, but, of course, they will become warm and once again need replenishing two or three times. Other suggested topical creams can include cortisone or capsaicin, both treating the itch in different ways, none of which are long-term solutions.
Oral medication, used alongside the topical creams are suggested. As understanding has increased about the aetiologies and pathophysiology of itch, new therapeutic strategies have emerged, including anti-seizure medications and antidepressants. Among the anti-seizure medications, gabapentin – widely used for neuropathic pain – is best studied.
As indicated previously, scratching excites inhibitory interneurons to release glycine and gamma-aminobutyric acid and thereby inhibit itch-responsive neurons. Another medication is a mild anti-anxiety drug for nerve pain, taken before sleep to help the sufferer get through the night.
There has been little published on surgery as a solution; it could be a bit drastic. However, when you start to research how many people suffer from this condition, it becomes apparent that some have suffered for 20-30 years.
If the condition is not understood, sufferers tend to keep quiet about it. There is nothing worse than scratching, madly, in public – people start to look at you and move away. How can you explain that you haven’t got anything contagious?
Other solutions have been suggested, such as traction applied by a qualified chiropractor or consulting a neurologist about peripheral nerve disorders. Ultimately, those who suffer from neuropathic itch have to find a short-term solution to relieve the discomfort.
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