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Brachioradial pruritus (BRP) is a localized pruritus of the dorsolateral aspect of the arm. BRP is an enigmatic condition with a controversial cause; some authors consider BRP to be a photodermatosis, whereas other authors attribute BRP to compression of cervical nerve roots.
BRP may be attributed to a neuropathy, such as chronic cervical radiculopathy. The possibility of an underlying neuropathy should be considered in the evaluation and treatment of all patients with BRP.
The main cause of BRP is not known, but there is evidence to suggest that BRP may arise in the nervous system. Cervical spine disease may be an important contributing factor.
Patients with BRP may have underlying cervical spine pathology. Whether this association is causal or coincidental remains to be determined.
There is controversy regarding the cause of brachioradial pruritus: is it caused by a nerve compression in the cervical spine or is it caused by a prolonged exposure to sunlight?
In many patients, itching of the arms or shoulders is seasonal. Some patients reported neck pain.
BRP can be linked to the thyroid.
Brachioradial pruritus (sometimes abbreviated BRP) is an intense itching sensation of the arm usually between the wrist and elbow of either or both arms. The itch can be so intense that sufferers will scratch their own skin to a bleeding condition.
The condition is becoming increasingly common, presenting in patients who are usually fair skinned and middle aged and indulge in golf, tennis, outdoor table tennis, sailing, or other leisure outdoor activities in sunny climates.
The cause is not known, although there are a few lines of thought on what causes it. No cure has been found. Many different medications and types of topical creams have been experimented with, but none seem to make any difference. The only thing that seems to help most sufferers is the application of ice to the area until the itch is diminished.
Approximately 280 million people globally, 4% of the population, have difficulty with itchiness. This is comparable to the 2–3% of the population suffering from psoriasis.
The exact mechanism of the condition is unknown, though some studies have suggested the itching occurs in response to increased fibrinolytic activity in the skin. Later studies indicated inappropriate activation of the sympathetic nervous system may play a part.
The correlation of notalgia paraesthetica localization with corresponding degenerative changes in the spine suggest that spinal nerve impingement may be a contributing cause. According to Plete and Massey, "The posterior rami of spinal nerves arising in T2 through T6 are unique in that they pursue a right-angle course through the multifidus spinae muscle, and this particular circumstance may predispose them to harm from otherwise innocuous insults of a varied nature." Patients may have other conditions that predispose them to peripheral neuropathies (nerve damage).
The causes of this condition have not yet been completely defined. Patients are usually older persons.
Aquagenic pruritus is a skin condition characterized by the development of severe, intense, prickling-like epidermal itching without observable skin lesions and evoked by contact with water.
Notalgia paraesthetica (NP) or notalgia paresthetica (also known as "Hereditary localized pruritus", "Posterior pigmented pruritic patch", and "Subscapular pruritus") is a chronic sensory neuropathy. Notalgia paraesthetica is a common localized itch, affecting mainly the area between the shoulder blades (especially the T2–T6 dermatomes) but occasionally with a more widespread distribution, involving the shoulders, back, and upper chest. The characteristic symptom is pruritus (itch or sensation that makes a person want to scratch) on the back, usually on the left hand side below the shoulder blade (mid to upper back). It is occasionally accompanied by pain, paresthesia (pins and needles), or hyperesthesia (unusual or pathologically increased sensitivity of the skin to sensory stimuli, such as pain, heat, cold, or touch), which results in a well circumscribed hyperpigmentation of a skin patch in the affected area.
One way to treat xerotic eczema is to avoid ing the affected area and to apply anti-itch or moisturizing lotion frequently.
A study published in 2005 found positive results from soaking the affected area in water for twenty minutes and then applying mid- to high-strength corticosteroid ointment.
Xerotic eczema (also known as "Eczema craquelé", "Pruritus hiemalis", "Asteatotic eczema", "Winter itch", "Desiccation dermatitis," and "Winter eczema") is a form of eczema that is characterized by changes that occur when skin becomes abnormally dry, itchy, and cracked. Lower legs tend to be especially affected, although it can appear in the underarm area as well.
Xerotic eczema is common in elderly people, though it is not uncommon for people in their 20s. It can appear in red, bumpy, pimple-like irritations. Shaving can cause it to become inflamed.
Itch is also associated with some symptoms of psychiatric disorders such as tactile hallucinations, delusions of parasitosis, or obsessive-compulsive disorders (as in OCD-related neurotic scratching).
CCCA tends to present itself in the 20s and progresses over 20–30 years. One should consider this diagnosis in African Americans with what appears to be a female-pattern hair loss.
Chronic and repetitive scratching, picking, or rubbing of the nodules may result in permanent changes to the skin, including nodular lichenification, hyperkeratosis, hyperpigmentation, and skin thickening. Unhealed, excoriated lesions are often scaly, crusted or scabbed. Many patients report a lack of wound healing even when medications relieve the itching and subsequent scratching.
Patients often:
- seek treatment during middle-age, although PN can occur at any age.
- have a history of chronic severe pruritus.
- have a significant medical history for unrelated conditions.
- suffer from liver or kidney dysfunctions.
- suffer secondary skin infections.
- have a personal or family history of atopic dermatitis.
- have other autoimmune disorders.
- have low vitamin D levels.
This is a skin disorder characterized by a self-perpetuating scratch-itch cycle:
- It may begin with something that rubs, irritates, or scratches the skin, such as clothing.
- This causes the person to rub or scratch the affected area. Constant scratching causes the skin to thicken.
- The thickened skin itches, causing more scratching, causing more thickening.
- Affected area may spread rapidly through the rest of the body.
Many hypothesize LSC has a psychosomatic origin. Those predisposed to itch as a response to emotional tensions may be more susceptible to the itch-scratch cycle. It may also be associated with nervousness, anxiety, depression, and other psychological disorders. Many people with LSC are aware of the scratching they do during the day, but they might not be aware of the scratching they do in their sleep. LSC is also associated with atopy, or atopic dermatitis (eczema).
The cause of prurigo nodularis is unknown, although other conditions may induce PN. PN has been linked to Becker's nevus, linear IgA disease, an autoimmune condition, liver disease and T cells. Systemic pruritus has been linked to cholestasis, thyroid disease, polycythaemia rubra vera, uraemia, Hodgkins disease, HIV and other immunodeficiency diseases. Internal malignancies, liver failure, renal failure, and psychiatric illnesses have been considered to induce PN, although more recent research has refuted a psychiatric cause for PN. Patients report an ongoing battle to distinguish themselves from those with psychiatric disorders such as delusions of parasitosis and other psychiatric conditions.
While the condition has been seen in over 60 breeds of dog (including cross breeds), certain breeds have been found to be more susceptible than others to sebaceous adenitis:
- American Akita and Akita Inu
- Standard Poodle
- Vizsla
- English Springer Spaniel
- Chow Chow
- Samoyed
- Weimaraner
- Havanese
Breeds also mentioned in scientific literature as having some susceptibility include:
- German Shepherd
- Dachshund
- Old English Sheepdog
- Lhasa Apso
- Boxer
- Collie
- Toy Poodle
- Mixed-breeds
Sebaceous adenitis has no sex-predisposition. Sebaceous adenitis also occurs in cats, rabbits and horses.
In most cases of bullous pemphigoid, no clear precipitating factors are identified. Potential precipitating events that have been reported include exposure to ultraviolet light and radiation therapy. Onset of bullous pemphigoid has also been associated with certain drugs, including furosemide, and other nonsteroidal anti-inflammatory agents, captopril, penicillamine, and antibiotics.
The Mazzotti reaction, first described in 1948, is a symptom complex seen in patients after undergoing treatment of onchocerciasis with the medication diethylcarbamazine (DEC). Mazzotti reactions can be life-threatening, and are characterized by fever, urticaria, swollen and tender lymph nodes, tachycardia, hypotension, arthralgias, oedema, and abdominal pain that occur within seven days of treatment of microfilariasis. The Mazzotti reaction correlates with intensity of infection; however, there are probably multiple infection intensity-dependent mechanisms responsible for mediating this complex reaction.
The phenomenon is so common when DEC is used for the treatment of onchocerciasis that this drug is the basis of a skin patch test used to confirm that diagnosis. The drug patch is placed on the skin, and if the patient is infected with the microfilaria of "O. volvulus", localized pruritus and urticaria are seen at the application site.
A case of the Mazzotti reaction has been reported after presumptive treatment of schistosomiasis and strongyloidiasis with ivermectin, praziquantel and albendazole. The patient had complete resolution of symptoms after intravenous therapy with methylprednisolone.
Riehl melanosis is a form of contact dermatitis, beginning with pruritus, erythema, and pigmentation that gradually spreads which, after reaching a certain extent, becomes stationary. The pathogenesis of Riehl melanosis is believed to be sun exposure following the use of some perfumes or creams (a photocontact dermatitis).
Bullous pemphigoid may be self-resolving in a period ranging from several months to many years even without treatment. Poor general health related to old age is associated with a poorer prognosis.
If a specific cause for pruritus ani is found it is classified as "secondary pruritus ani". If a specific cause is NOT found it is classified as "idiopathic pruritus ani". The irritation can be caused by intestinal parasites, anal perspiration, frequent liquid stools, diarrhea, residual stool deposits, or the escape of small amounts of stool as a result of incontinence or flatulence. Another cause is yeast infection or candidiasis. Some diseases increase the possibility of yeast infections, such as diabetes mellitus or HIV infection. Treatment with antibiotics can bring about a disturbance of the natural balance of intestinal flora, and lead to perianal thrush, a yeast infection affecting the anus. Psoriasis also can be present in the anal area and cause irritation. Abnormal passageways (fistulas) from the small intestine or colon to the skin surrounding the anus can form as a result of disease (such as Crohn's disease), acting as channels which may allow leakage of irritating fluids to the anal area. Other problems that can contribute to anal itching include pinworms, hemorrhoids, tears of the anal skin near the mucocutaneous junction (fissures), and skin tags (abnormal local growth of anal skin). Aside from diseases relative to the condition, a common view suggests that the initial cause of the itch may have passed, and that the illness is in fact prolonged by what is known as an itch-scratch-itch cycle. It states that scratching the itch encourages the release of inflammatory chemicals, which worsen redness, intensifies itchiness and increases the area covered by dry skin, thereby causing a snowball effect.
Some authorities describe “psychogenic pruritus” or "functional itch disorder", where psychological factors may contribute to awareness of itching.
Ingestion of helminth (worm) "Enterobius vermicularis" (pinworm, or threadworm) eggs leads to enterobiasis, indicative of severe itching around the anus from migration of gravid females from the bowel. Severe cases of enterobiasis result in hemorrhage and eczema.
Summer penile syndrome (also known as 'Lions Mane Penis') is a seasonal pediatric medical condition characterized by redness, swelling (Edema), and itching (pruritus) of the penile skin.
Summer penile syndrome is usually caused by chigger bites on the penis. Majority of cases occur in the summer months, with the clothing associated with warmer weather making penis-insect contact more likely.
The signs of sebaceous adenitis are caused by an inflammatory disease process which affects the sebaceous glands of the skin. The cause of the inflammatory disease is unknown. Different breeds of dogs may have different underlying causes of the disease.
Research is currently underway to find if there is a genetic predisposition for sebaceous adenitis; the exact mode of inheritance remains unknown.
In Standard Poodles, sebaceous adenitis is most likely an autosomal recessive inherited disease, with variable expression.
Central centrifugal cicatricial alopecia (CCCA), also referred to as hot comb alopecia and follicular degeneration syndrome, is a type of alopecia first noticed in African Americans in the 1950s and reported by LoPresti et al. in 1968 as a result of application of petrolatum followed by a stove-heated iron comb. The original theory was that the hot petrolatum would travel down to the hair root, burn the follicle, and after repetitive injury scarring would result. Later CCCA was realized to affect men and women without a history significant for use of such styling techniques. Consequently, the terms "follicular degeneration syndrome" per Sperling and Sau in 1992 and then CCCA per Olsent et al. in 2003 were evolved. Plausible contributing factors may include other African-American styling techniques such as relaxers, tight braids, heavy extensions, certain oils, gels or pomades.
Papular purpuric gloves and socks syndrome is a cutaneous condition characterized by pruritus, edema, and erythema of the hands and feet, occurring primarily in teenagers and young adults.
An association with parvovirus B19 has been described.