A New Explanation for Intensely Itchy Arms

Cynthia Bailey, MD|February 9, 2011

  I seitchy arms Best summer skin care for smooth skine many patients who suffer from an intense and seemingly inexplicable itchy arms. Until now, we doctors haven’t been able to explain why this happens- but at last there's a conclusive answer. Like nostalgia paresthetica, the problem is apparently caused by a nerve impingement in the spine!

For me, this answer is one of my highlights from the American Academy Of Dermatology’s Annual meeting in New Orleans; when science figures out the cause of some mystery condition that I treat every day, I'm thrilled.

The Diagnosis is Brachioradial Pruritus

It’s another one of those strange conditions where a precise part of the skin itches intensely but yet it looks entirely normal. Patients can actually draw on their skin exactly where the itchy area stops and starts. I’ve been able to give my patients the name of the condition, but it’s been frustrating for all of us because I haven’t been able to give them a good explanation for the problem. Now I can. Of course there are many other reasons why arm skin can itch, but usually there’s a rash on the arm skin and possibly on other parts of the body too. Common examples include dry skin, a contact allergic reaction like poison oak or wool allergy, psoriasis, etc. But when you have brachioradial pruritus, the intensely itchy skin looks completely normal before you start scratching. My right arm has the itch of brachioradial pruritus so I get to "observe" the condition daily. (There are other conditions where it's possible to have total body itching with no visible rash on the skin, but in brachioradial pruritus the itching is limited mainly to the arms.)

How Do You Know if You Might Have Brachioradial Pruritus?

Brachioradial pruritus usually begins in adulthood, especially if the skin on your arms is sun damaged. In fact, sun exposure may also trigger the onset of itching. The skin looks normal unless if you’ve been scratching. Unlike nostalgia paresthetica, the central back itch, your arms are right there for you to scratch and the itch is almost irresistible. Years of scratching will cause a callusing and roughness of the skin, ultimately leading to white, red, and brown scars.  These are "secondary skin changes" because they’re due to scratching. There are no primary changes (changes due to a rash) because the underlying skin is actually normal. Both arms are usually affected but often the driver’s side arm is worse. The most common area of your arms to be involved is the forearm near the elbow, but any area on the arms, upper back, and neck can be affected. Itching is usually described by patients as a burning, prickling, or stinging sensation.  Like nostalgia paresthetica, the involved skin is hypersensitive to touch. Even light touch can set off the itching process. Sunlight can start it up too. The New Nerve Impingement Explanation for Itchy ArmsItchy arms and skin We've suspected nerve impingement to be the cause of both brachioradial pruritus and notalgia paresthetica, but now it's conclusive! Since the arms are involved, the impinged nerves are coming out of the cervical spine, so it’s cervical spinal abnormalities that cause the nerve impingement. Also, like notalgia paresthetica, the spinal abnormalities don’t need to be severe; they can be just a slight bulge of a disk, calcium spurs coming of the vertebrae, or other spinal changes that accompany aging. There also seems to be a role for sun damage in brachioradial pruritus.  It may be that both the nerve impingement and the degenerative changes in the skin that occur from sun damage are both necessary to cause the problem.

What can you do to lessen your itchy arms if you have brachioradial pruritus

Treatment is tricky because the skin is actually normal and the message of "itch" emanates from the nerve near the spine, but there are things we can do to lessen the itch. Sun Protect Your Arm Skin We know that sun plays a role in the problem, so, of course, sun protection is important. The best protection comes from wearing sun protective shirts that cover your arms. If that's not possible then the mineral micronized zinc oxide sunscreens are best because, unlike chemical sunscreens, heat is not created when the UV rays hit the active sunscreen ingredients. Heat can make the itch worse. My favorite micronized zinc oxide sunscreen for the arms is Solbar Zinc.

Click here to see more about Solbar Zinc Sunscreen.

Solbar Zinc Sunscreen

"Thank you, thank you, thank you." "My arms began itching about three years ago during the summer. The condition seemed to worsen during the following years. My dermatologist prescribed topical lotions and an antihistamine which helped, but I continued to need ice daily to ease the unbearable itching. A friend recommended your website as a resource. I began using AmLactin after each shower and Solbar before going outdoors. I’ve only used ice once or twice during the last three months.

I continue to use my prescription for Pramosone 2.5% lotion occasionally when I feel an itch coming on, but I’m now practically itch free."  Linda M. A August 2012 

 

Keep Your Arm Skin Well Moisturized and Free of Flaky, Dry Scale Tickling dry skin scale sets off the itch, so moisturizing is really important. (Think of dry skin scale like tiny feathers brushing over your skin and tickling you.) I described my moisturizing recommendations in my post on nostalgia paresthetica. If your skin is really dry and irritated you will need to start with bland, rich moisturizers. Eventually though, glycolic acid products will work the best to control flaky scale. My favorite way to keep itchy arm skin well moisturized and free from tickling dry scale is with my Anti-Aging Body Kit. The products are used to keep your skin from becoming scaly, not for anti-aging purposes, and they are highly effective at doing the job.

Click here to learn more about my Anti-Aging Body Skin Care Kit.

Anti Aging Products for the body

When Itchy Arms Occurs:

  • I tell my patients to slap an ice pack on the itchy skin because when the nerve is so busy telling you your skin is cold it can’t tell you that your skin itches.
  • I also stress the importance of not scratching! Scratching causes skin nerves to thicken up and send even louder itch messages to your brain in the future.
  • Anti-itch creams with pramoxine or menthol sometimes help and can be used on an as needed basis numerous times during the day. If you keep them in the fridge they are cool too, providing additional benefit for your itch.

Scratching also eventually causes scarring and uneven pigmentation. This can be disfiguring, so we need to find some other solution for the itch. If sun avoidance, moisturizing, anti-itch creams, and the occasional ice pack don’t control the itch then I prescribe a topical cortisone cream to apply while my patient is going through an itchy spell. If none of this provides sufficient relief, then just like nostalgia paresthetica, there are strong oral medicines that can help block nerve signals. They have a lot of side effects and I only prescribe them for my patients as a last resort. (If you think you have this diagnosis and need prescription treatment you must discuss your situation with your personal doctor.)

If you found this itchy arms information helpful you may also want to read:

Facial Skin Care for problem Skin with Rosacea, Seborrhea and Clogged Pores Cracked, Dry Brittle and Splitting Fingernails: Dermatologist's Tips  

If you have found this itchy arms article and tips useful, thank you for sharing this in social media, your comments and questions

wow.  I think I have this. I have tried perscripton hydrocortisone to no avail. so I’m scared nothing will work but a pill with side effects.  how about chiropractic? I’m surprised that wasnt mentioned.

By Del on 2016 09 25

This article has been a great help and just having a name and explanation for my symptoms has been a great relief.  I have had itchy stinging arms for several years. I have always found it helps running my arms under cold water and using a flexible ice pack has been a great help until the itching subsides.  I have noticed my symptoms occur more severely after I have had exposure to the sun.  When I have servere spells of itching but more stinging skin, I use cold water dousing, with ice packs and paracetamol.  The stinging will stop for several hours after this treatment.  Bliss.  I always use E45 cream straight after a morning shower to keep my skin moisturised and also because sometimes my legs, neck and shoulders start itching and stinging.  When this happens I definetely reach for the paracetamol. I recently had a heart attack so I am limited to the types of medications I can take on top of my heart Meds.  So I hope the treatment and the paracetamol continues to work for me.  Thanks for the advice and thanks for explaining to me what I am experiencing.
Bill.

By Bill coughlin on 2016 09 28

Thank you so for writing this article. I have suffered with this problem for the last 2-3 years and the onset is usually in September and in the evenings which is strange but I put it down to not drinking enough fluids, change in the climate and also that I start wearing sleeved tops again after the summer months. I too use ice packs when it is unbearable and smoothering my arms in cold Aloe Vera gel / Aveeno which works for a short period of time along with an antihistimine but I think I will give Amlactin and Solbar a whirl too….anything to stop the incessant itching.  Thanks again for putting a name to the condition.

Lizzy

By Lizzy Finnigan on 2016 10 05

Hello Lizzy, Bill and Del,
Thanks for you comments. Del, yes chiropractic is another option as is acupuncture, Feldenkrais, yoga, massage etc. I have several other articles on the subject if you are interested. It is a common condition that vexes many of us. Here are some links:
https://www.drbaileyskincare.com/info/blog/what-causes-itching-in-the-middle-of-the-back
https://www.drbaileyskincare.com/info/blog/what-causes-itchy-arms
https://www.drbaileyskincare.com/info/blog/dermatologist-discusses-genital-and-anal-itching

By Cynthia Bailey, MD on 2016 10 06

I have suffered three years with Brachioradial Pruritus, When I first started to itch I went to the Drs several times and they could never find any thing wrong and just kept on giving me tablets and creams but they never worked, I found myself taking 28 piriton a day…..my GP good as said it was all in my mind. My son made me appointment to go and see the GP and demanded a second opinion, soon as I seen another DR he said straight away what I had, he then prescribed me amitriptyline which is known as a anti depressant but is very good for the nervous system this worked with in a couple of days. I have been free from itching for 18 months apart from now but all I have done is put a ice pack on the itchy arm this works wonders.

By Patricia Bushby on 2016 10 12

I have found it is formaldyhyde in cotton sheets and clothes which causes this intense itching.  Change your bedding and clothing to organic.

By diane on 2016 10 13

Thank you for this blog.  For years I have experienced a no rash itchy arm problem.  During the summer months it is almost intolerable.  The only thing that helps is cold packs & rubbing topical gels such as ice gel or similar. I have been to numerous dermatologists and no-one has been able to help, suggest a treatment or tell me what is causing it or what it is.  I have to believe I am allergic to the sun….......but only on my arms as the itch is not on any other part of my body even though it has been exposed??

By Ann Robinson on 2016 10 13

I’ve got all the symptoms described in your first blog, the more I scratch my arm the more it itches, many times I draw blood, just knowing that I’m not going crazy and it’s not all in my mind has been a great help, I was beginning to think I am the only person in the world that this is happening to, I had some tingling in my arms when I sleep with my arms bent up, my GP suggested a Vascular Surgeon, the appointment took five months, eventually I got to see him, he said I think it’s stemming from a Nerve in your neck and sent me for a MRI scan on my neck, I received a letter yesterday with another appointment to see him again next month, this has now been going on for some two and a half years and you have explained the problem in less than two minutes, as others have said although it’s mainly my right arm around the Elbow area I also get itches on the top’s of me feet and the backs of my hands, and I also get itches in the middle of my back just where I can’t reach, now I understand what the cause is I can set to trying to get it sorted, Thank you very much for the information and the explanation now I will try to find the solution, thank you once again.
By: Dennis Firmin 2016 10 14    
Thank you for sharing your story Dennis. This is a vexing problem that is just starting to be sorted out by medical science. Warm Wishes, CBMD

By Dennis Firmin on 2016 10 14

Hello Patricia, Diane and Ann,
Thank you for sharing your stories. New readers coming to this post will be helped as you all have gained great insight into how to sooth your particular problems with this vexing problem of brachioradial pruritus. I always recommend that my patients with this problem keep their arm skin really healthy, well moisturized and sun protected. The hypersensitivity of the itch cascade can be triggered by such simple things as dry skin scale tickling on fabric or a breeze, heat or sun etc. It is one of those ‘holy grail’ problems that we dermatologists try to guide patients through. Thank you for sharing your lessons and insights.
Warm Regards, CBMD

By Cynthia Bailey, MD on 2016 10 16

Omg!!! This is me!!! I’ve been itching my left arm for over 2 months. My GP had no clue and sent me to get allergy tested with no explanation. If it is due to a nerve being compromised in the neck, I’m having a craniectomy with decompression of c1 and c2 in 6 weeks for my chiari. My cerebellum is protruding into my cspine and pressing on my nerves. I hope and pray this will solve this itching that is getting worse. I’m so glad I found with article!!!

By Karry Krueger on 2016 10 18

Thank you so very much everyone for this wonderful insight. I too have one itchy arm for the past 6 months to year. Some nights it keeps me awake for hours to no avail. I thought that I was going crazy seeing there was no rash or raised skin. The last few months it has been increasingly itchy. I was trying to pinpoint what was triggering it. We have moved to a hot climate in the last 2 years, and the sun can be strong. Now it all makes sense as we have just come out of the sunniest and hottest month.The icepack works for me. I am going to try acupuncture now that I know.
Thanks you everyone

By Michelle G on 2016 10 20

Which Amlactin do you use? Hello Lou Ann, the original lotion. I’ve had some patients prefer the Ultra which has their proprietary “ultraplex” that they won’t describe but that may be nice for some.

By Lou Ann on 2016 10 20

Hello Karry and Michelle and thank you for your gratitude. This is indeed a vexing problem and I’m glad to provide info. Lou Ann, I answered your question in your comment. Thanks!

By Cynthia Bailey, MD on 2016 10 25

Hi
I have had this condition for over twenty years, and have been told that it is pruritus.  My arms itch, burn, sting and prickle intensely, it keeps me awake at night.  The itching starts in the first week of September and lasts until February or March and this has been the same pattern for over twenty years.  The arms look normal and only become red and sore looking after scratching which I try not to do, but I do it in my sleep.  I also have problems with wear and tear of the discs in the top and bottom area of my back, and my spine is off set, so it looks like I do have this condition.
Thank you for the information.
Ann

By Ann on 2016 10 26

Hi I also have had this condition for years, it starts about August and goes right through till December then stops witch baffles me, my three daughters also have this same problem. It’s mostly my left arm sometimes round my upper arm and neck last summer I changed my sun cream to P20 and I didn’t have the itch but this year I used a couple of creams and I’m wondering could this be a cause I’m going crazy this time. Thank you for your information on this horrible problem it’s great to hear that it’s been recognised as my doctor was lost.

By Sarah on 2016 10 30

i suffered with this many years ago and the GP couldnt find a solution for me until i went to see a Consultant and he prescribed a cream that had to be made up and it worked.  i didnt have another bout of it until quite a few years later and i went to the same GP but he was unable to find the cream in my notes but he did have a search made of my earlier notes and prescribed it again.  it did the trick.  i have kept that cream and tonight i have exactly the same problem.  the itching is driving me crazy and i cannot sleep.  i am a Diabetic 1 and suffer with neuropathy i am 64 and have had Diabetes since i was 12.  i decided to surf the net and found this website.  i am so pleased i now have some answer to the itching which is terrible i run my right arm under the cold water tap because i succumbed to scratching and have put the cream on.  i am hoping it will do the trick but i do take amitriptyline in very very small amounts when i get very bad neuropathy in my toes but find it zonks me out the next day so try not to take that except in dire straits.  i am pleased i have a name for my problem and thank you .

By susan on 2016 11 01

I am so pleased to have read all your interesting stories ,as i too suffer with the symptoms of both arm’s itching and stinging to the brink of driving me mad it’s impossible not to scratch as it becomes so intense but the more you scratch the more it itches ,i also have problems with my back and neck due to arthritis ,many a night i have had to go to the freezer for an ice pack it’s the only thing that works to enable me to get to sleep ,i have taken all sort’s of lotions , potions and tablets ,but feel crazy when booking an appointment for the doctors and having not a lot to show apart from small white scar like spots , it will always start up around September and goes away around March time ,this has been the same pattern for the past seven years ,i have today bought some calamine lotion so sat here with white arms ,anything is worth a try ,but it’s great to have a name to our symptom’s ,thank you for all your post’s Catherine Xx

By Catherine on 2016 11 02

I have been dealing with the intense hitching since I was 10 years old, I’m now 55.  It mostly start at the end of September and last until the end of February or March.  Summer seem to provide a relief as I dont experience any itching at all.  Like it was mentioned here, it occur mostly on the face of both arm at the elbow level, but also on the side of the wrist, I have more itching on the left side.  Ironically it itch exactly at the same area on one arm or the other, it can switch within one arm to the other in a matter of minutes.  Yesterday while watching the World series, it was the worst evening in a long time, my right arm itched for a couple of hours and even if i try to resist as much as I can to scratching, at some point you start scratching without realizing as i tried to not focus on it.  I have consulted my doctor about that, but at that time it seem that no one knew about Brachioradial Pruritus.  I’m going to try ice next time, but if I can get a cream or something that could ease the harch rash, it would be certainly appreciate.  I have learn to live with this, it use to really bother me when I was younger, as some point I have scratched to the point where the skin start to come off and bleeding occur, that was driving me crazy.  I guess that because I am use to it I try to not pay attention to it too much.  I’m going to consult a Dermatologist, I would definitely prefer to get some treatment that treat the cause and not the symptoms but since I have been dealing with this for so long that I can deal with it a little longer.  Just so you know, I am a healthy person and in very good physical condition, I train 4 times a week, doing weight lifting, cardio, stretching etc.  I practice meditation and eat well.  I dont smoke or take drug, I drink very little alcool, a glass of wine once in a while and that’s about it. 

By Andre Allaire on 2016 11 03

I wonder if an inversion table would help. Has anyone tried one for this problem.
Regina

By Regina Ellington on 2016 11 04

This is the best information.  As I read all of the “this is me!!”, I feel like I am not alone to the “scratchies” that at times have actually caused me to stab my arms with a fork, to try and stop the mass itching on my arms.  Ice does help the best, but I am going to try the couple of other medicines someone mentioned above.
I am also extremely healthy, do muay thai kickboxing, drink plenty of fluids, eat healthy, etc.  This has absolutely no effect or bearing on the itching of the arms.

By Angela on 2016 11 07

Add Your Comment