A Rare Manifestation of Sunburn Rash: A Case Report of Brachioradial Pruritus

Brachioradial pruritus (BRP) is a type of localized neuropathic dysesthesia of the dorsolateral upper extremities that is commonly found in fair-skinned females. It is worsened by exposure to bright sunlight or ultraviolet radiation (UVR), a subtype of neuropathic pruritus that is delayed and difficult to diagnose. It typically involves a combination of C5-C6 dermatomal distribution of the dorsolateral arm (often bilateral), spinal abnormality, and radiculopathy. The ice-pack sign is universally known to be associated with BRP. We present a case of a 41-year-old Caucasian female who presented with complaints of sunburn to bilateral arms, pins and needles, and extreme itching sensation in the bilateral upper arms. The patient tried lotions, cortisone cream, and oral Benadryl without relief. The patient reported that the rash worsened with heat and improved with ice packs. On the primary survey, vitals were stable, but the presence of dark erythema on the bilateral upper arms was visible. The patient was recommended to apply silver sulfadiazine 1% cream twice daily, oral gabapentin 300 mg twice daily, and topical diclofenac gel as needed. The patient saw a primary care physician (PCP), dermatology, and neurology, with broad differential diagnoses, and underwent several treatments for other diseases, but the primary diagnosis of BRP was not established. Early recognition and diagnosis of BRP, by taking a thorough history and physical exam, and utilization of the ice-pack test, is critical for prompt management and avoiding unnecessary workup.