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

"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]. Since, several patients from temperate zones showing seasonal occurrence of brachioradial pruritus have been described [3-9].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]. In favour of this hypothesis is a report on 22 patients with brachioradial pruritus of whom 11 had cervical spine radiographs showing pathological changes correlating with the location of pruritus in each of these 11 patients [11]. In the Hawaiian patients of Walcyk and Elpern, radiographs of 15 patients showed changes only in the older, arthritis-age groups [2].The present report concerns investigation of the density of the sensory nerve fibers in skin biopsies taken from the affected skin in the itchy period and in the symptomless period as well as radiography of cervical spine in four sisters with brachioradial pruritus. The pedigree of the three generations of the family of the sisters as well as the radiological findings of the cervical spine in these patients has been reported previously [12].In the present study skin biopsy specimens from itchy skin were collected in October and were compared with biopsies from adjacent skin collected in March when the patients had no itch. The cutaneous innervation was visualized by antibodies against a pan-neuronal marker, protein gen