Brachioradial Pruritus NHS | A4 Medicine
                     BRACHIORADIAL 
PRURITUS  
NHS
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uk
BRACHIORADIAL PRURITUS NHS IS DEFINED AS AN UNPLEASANT SENSATION OF 
SKIN LEADING TO THE  DESIRE TO SCRATCH ( ITCH )
COMMON DERMATOLOGICAL PROBLEM OFTEN INTRACTABLE WITH A HIGH IMPACT ON 
QUALITY OF LIFE  INCREASES WITH AGE ESTIMATED THAT 60 % OF PEOPLE > 65 
SUFFER FROM MILD TO SEVERE  OCCASIONAL PRURITUS EACH WEEK EXACT 
PREVALENCE IS NOT KNOWN CAN BE CAUSED BY BOTH SKIN  AND SYSTEMIC 
PROBLEMS INTERNATIONAL FORUM FOR THE STUDY OF ITCH HAS SUGGESTED A  
CLASSIFICATION WHICH CONSIDERS CLINICAL AS WELL AS DIFFERENTIAL DIAGNOSTIC 
REASONS  SYSTEMIC CAUSES- METABOLIC AND ENDOCRINE ♦  CHRONIC RENAL 
INSUFFICIENCY♦   HYPERPARATHYROIDISM ♦  HYPER & HYPOTHYROIDISM ♦  
CARCINOID SYNDROME ♦  DIABETES  HEPATIC ♦  PBC ♦  EXTRAHEPATIC BILIARY 
OBSTRUCTION ♦  CHOLESTASIS OF PREGNANCY ♦   HEPATITIS♦  ORAL 
CONTRACEPTIVES ♦  DRUG INGESTION INFECTIVE DISEASE ♦  HIV AND AIDS ♦   
PARASITOSES INCLUDING HELMINTHOSIS HAEMATOLOGICAL ♦  POLYCYTHEMIA VERA
♦   MYELODISPLASTIC SYNDROME ♦  LYMPHOMA EG HODGKINS LYMPHOMA ♦  
MULTIPLE MYELOMA ♦   IRON DEFICIENCY NEUROLOGICAL DISORDERS ♦  MULTIPLE 
SCLEROSIS ♦  BRAIN TUMOURS ( EG  GLIOMAS ) ♦  NOTALGIA PARAESTHETICA ♦  
BRACHIORADIAL PRURITUS ♦  PERIPHERAL NEUROPATHY  PSYCHIATRIC OR 
PSYCHOSOMATIC DISaE4AmSEeSdicine.co.♦u kD/EgPeRnEeSrSaIlOisNed♦-p AruFrFiEtuCTs-IVE DISORDERS ♦   
HALLUCINOSIS ♦  OCaD4♦m SeCdHicIZinOeP/HRENIA ♦  EATING DISORDERS
DERMATOLOGICAL CAUSES-XEROSIS SCABIES DERMATITIS HERPETIFORMIS ATOPIC 
DERMATITIS LICHEN SIMPLEX  PSORIASIS LICHEN PLANUS CONTACT DERMATITIS MILIARIA 
DRUG REACTIONS INSECT BITES PRURITIC  URTICARIAL PAPULES AND PLAQUES OF 
PREGNANCY PEDUCULOSIS URTICARIA FOLLICULITIS SUNBURN  POLYMORPHOUS LIGHT 
ERUPTION BULLOUS PEMPHIGOID PEMPHIGUS FOLIACEUS PITYRIASIS ROSEA FIBERGLASS  
DERMATITIS FUNGAL INFECTIONS MYCOSIS FUNGOIDES SEBORRHOEIC DERMATITIS
HISTORY-ONSET , DURATION INTENSITY TIMING ITCH CHARACTERISTIC FOR EG
PRICKLING CRAWLING BURNING  RASH ? SITE EG ENTIRE SKIN
PALPEBRAL CONJUNCTIVA PERIANAL / PEROGENITAL EAR CANALS , 
EYELIDS,  NOSTRILS ASSOCIATED SYMPTOMS DISTURBING SLEEP ? RELIEVING FACTORS 
MEDICAL HISTORY DRUG HISTORY ,  COSMETICS , CREAMS ? BLOOD TRANSFUSIONS OTHERS 
ITCHING ? ( SCABIES ) ALCOHOL ABUSE , SEXUAL HX ,  DRUG ABUSE DIETARY HISTORY
EXAMINATION ASSESS SEVERITY FOR EG USING AN VISUAL ANALOGUE SCORE ( VAS ) SKIN 
EXAMINATION MUCOUS  MEMBRANES SCALP HAIR NAILS ANOGENITAL REGION DISTRIBUTION 
OF PRIMARY AND SECONDARY SKIN LESIONS  SKIN SIGNS OF SYSTEMIC DISEASE PALPATION 
OF LIVER , KIDNEYS , SPLEEN AND LYMPH NODES MENTAL STATE –  PSYCHOLOGICAL IMPACT
TESTING- RENAL FUNCTION FBC , ESR LFTS , BONE PROFILE , VIT D , BL GLUCOSE , HBA1C TFTS 
IRON STUDIES  BLOOD MORPHOLOGY , LDH ANA HIV AND HEPATITIS A, B AND C SEROLOGY 
ELECTROPHORESIS IGE SERUM LEVELS  ( TOTAL AND SLLERGEN SPECIFIC ) STOOL TEST FOR 
OVA , PARASITES OR BLOOD PRICK TESTS WITH SPECIFIC  ALLERGENS MICROSCOPY OF SKIN 
SCRAPINGS DERMOSCOPY SKIN BIOPSY CXR CT SCAN OF NECK , THORAX ,  ABDOMEN AND 
a4medicine.co.uk/generalised-pruritus-
PELVIS MRI OF BRAIN AND SPINAL CORD RED FLAGS-BULLOUS PEMPHIGOID HODGKINS 
LYMPHOMA  POLYCYaT4HmEMeIdAi VciEnReA/ HIV INFECTION / AIDS PARANEOPLASTIC PRURITIS BRAIN 
TUMOUR STROKE
MANAGEMENT- WHERE POSSIBLE MANAGE UNDERLYING CAUSE DISCONTINUE DRUGS WHERE 
POSSIBLE  EMOLLIENTS WITH ACTIVE INGREDIENTS FOR EG MENTHOL 0.5 % OR 1 % , PHENOL
OR CAMPHOR TREAT SKIN  INFECTIONS TOPICAL THERAPY CAPSAICAN PARTICULARLY RENAL 
( POOR PT COMPLIANCE ) , TOPICAL DOXEPIN ,  CROTAMION CREAM SYSTEMIC THERAPY 
( SEEK ADV FROM DERMATOLOGY WHERE APPROPRIATE ) ♦  SEDATING  ANTI-
HISTAMINES EG HYDROXYZINE ( ATARAX ) 10-25 MG NOCTE ♦  NON SEDATING ANTI 
HISTAMINES EG  FEXOFENADINE 180 MG ♦  ANTI-DEPRESSANTS EG TRICYCLICS 
( AMITRIPTYLINE , DOXEPIN ) , SSRIS (  PAROXETINE ) , MIRTAZEPINE @ 15 MG ♦  ANTI-
CONVULSANTS AND PAIN MODULATORS – EG GABAPENTIN OR  PREGABALIN ♦  OPIOID 
RECEPTOR ANTAGONISTS ; AGONISTS EG NALTREXONE ♦  RIFAMPICIN ( HEPATIC  PRURITUS ) , 
CHOLESTYRAMINE ♦  ONDANSETRON , NSAIDS , H1 AND H2 ANTAGONISTS IN COMBINATION 
FOR EG  FEXOFENADINE AND CIMETIDINE UV PHOTOTHERAPY PSYCHOSOMATIC THERAPY
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