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Thank you for the information. The two possibilities in your case are Neurodermatitis
and Brachioradial pruritis
is a condition where the nerves in any area of the body become hypersensitive and fire under normal conditions to produce a sensation of itching
. The primary problem is itching and any skin rash, redness or excoriation is secondary to the scratching. The skin may look absolutely normal. The sites can be very localized as in your case where symptoms are limited to the forearms. Itching is characteristically worse in the evenings. Stress often makes this itching worse.
This leads to an 'itch scratch cycle
'. As in the more one scratches the more the area itches and so on. The first step in treatment is to break this cycle by giving relief from itching and instructing the patient to avoid scratching as much as possible. Nerodermatitis
is much easier to treat so I would recommend trying this first:
1. Jergens Naturals Ultra Hydrating Daily Moisturizer
applied three to four times a day - under wet wrapping of bandage at night over the limbs if possible. Mix Fucibet
or 1% Cortizone
cream with the morning and night time application of the moisturizer.
After a few weeks gradually taper Fucibet cream - once at night for 1-2 weeks and then alternate day and so forth.
3. Tab Atarax
25 mg thrice a day. Atarax may require a prescription, you can use Tab Claritin
10-20 mg twice a day instead.
4. Neutrogena body oil once or twice a day is also very beneficial, particularly after bathing.
5. Stop using soaps - use a soap free cleanser like Nivea soap free body wash or Elovera body wash instead. Bath oils are also helpful.
6. Omega-3 fatty acid capsules
- take one morning and evening after meals.
7. As far as possible try not to scratch the affected areas as this leads to more itching.
NOTE: Barring Fucibet and Atarax all of the above are available without a prescription.
If there is no significant improvement in 2-3 weeks of the above regimen then the diagnosis is most likely Brachioradial pruritis
. Here is a link to understanding the condition: http://dermnetnz.org/site-age-specific/brachioradial-pruritus.html
Many cases benefit from acupuncture. Correction of any cervical spine abnormality generally leads to a prompt resolution of symptoms and for this you would have to schedule a consult with both a neurologist & if required a neurosurgeon. Please note quite often cervical problems may be asymptomatic and only picked up on a scan.
Brachioradial pruritis otherwise can be quite difficult to treat but the following should help:
1. Capsaicin cream: applied 3-4 times a day over the affected area. Takes 4-6 weeks to start working
2. Tab Doxepin 25 mg once at night.
3. Cool compresses(with wrapped, crushed ice) to the affected part when the itching is unbearable.
4. Tab Gabapentin 300 mg once a day for 7 days, then dose increased by 300 mg every 4th day (i.e 300 twice a day, then 300 morning, 600 night, then 600 twice a day etc) - till the itching subsides or a maximum dose of 2400.g/day is reached or the dose cannot be increased any more because of excessive sedation.
5. An SPF 50+ sunscreen should be used over the arms in the morning and afternoon and excessive sun exposure should be avoided.
Please note: When the dose of gabapentin exceeds 600mg/day, stop the doxepin.
5% Lidocaine gel & Doxepin gel applied over the affected area has also shown benefit in some patients. These can be tried if the capsaicin does not help. Please note that all of the above will require a prescription.
Hope this information is helpful. I would recommend discussing my recommendations with your doctor when possible.