Self-healing photo-neuropathy and cervical spinal arthrosis in four sisters with brachioradial pruritus

Joanna Wallengren

doi:10.1186/1749-7221-4-21

Abstract

The cause of brachioradial pruritus (a localized itching on the arms or shoulders) is controversial. The role of sun and cervical spine disease has been discussed. This is a report on four sisters suffering from brachioradial pruritus recurring every summer. The sisters spent much time outdoors and exposed themselves extensively to the sun. They also had occupations requiring heavy lifting. Cervical radiographs indicated arthrosis. The density of sensory nerve fibers in the skin biopsies from the itchy skin of the arms, visualized by antibodies against a pan-neuronal marker, protein gene product 9.5, was reduced compared with biopsies from the same skin region during the symptom-free period in the winter. This data exemplifies that brachioradial pruritus is a self healing photoneuropathy occurring in middle aged adults predisposed by cervical arthrosis.

Highlights

Letter "Solar pruritus of the elbows or brachioradial summer pruritus," a localized itch of the skin on the dorso-lateral aspect of the arm, was first described by Waisman in Florida 1968 [1]
Walcyk and Elpern, who described 42 Hawaian patients with chronic intermittent pruritus, suggested brachioradial pruritus to be a photo-neurological disorder caused by sun-induced damage to nerve endings that results in pruritus and altered sensation in susceptible individuals [2]
Several patients from temperate zones showing seasonal occurrence of brachioradial pruritus have been described [3,4,5,6,7,8,9]. Another hypothesis concerning etiology of brachioradial pruritus was presented by Heyl in South Africa, who suggested that this disorder may be caused by nerve injury to the cervical spine or by nerve compression at other locations because 5 out of his 14 patients had a history of neck trauma or arthritis [10]