Pruritis

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of itching

Location is on ‍rightleftboth ‍faceneckarmhandlegfootthoraxabdomenbackgeneralized

Onset was ‍gradualsudden, ‍spontaneouswhileafter ‍



Symptoms include:

‍itching

‍redness

‍rash

‍dry skin

‍scaling

‍bumps on the skin

‍blisters

‍crusting or oozing



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍recent exposure to new products

‍new detergent

‍pregnancy

‍stress

no history of: ‍chronic pruritus, ‍eczema, ‍allergies, ‍liver disease, ‍chronic kidney disease

no use of: ‍opioids, ‍new medications





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Skin: ‍rashlesions on ‍





ASSESSMENT:

‍Contact dermatitis ‍likelysuspectedpossible

DDx: atopic dermatitis, contact dermatitis, xerosis (dry skin), scabies, psoriasis, lichen planus, urticaria, drug eruption, chronic idiopathic pruritus, cholestatic pruritus, uremic pruritus, aquagenic pruritus, psychogenic pruritus, neuropathic pruritus, iron deficiency anemia, thyroid disorders, diabetes mellitus, lymphoma, HIV infection, hepatitis C, renal failure, pregnancy-related pruritus, insect bites, parasitic infestations, folliculitis





PLAN:

Investigations:

- Blood work: ‍CBC, ‍LFTs, ‍BUN, ‍Creatinine, ‍TSH, ‍Iron studies, ‍HIV, ‍Hepatitis B, ‍Hepatitis C

- Allergy testing

- Stool for ova and parasites

Treatments:

- ‍Topical corticosteroids

- ‍Topical calcineurin inhibitors

- ‍Antihistamines

- ‍Prednisone

- ‍Emollients

- ‍Phototherapy

- Avoidance of irritants and allergens

- Education on proper skin care and avoidance of triggers

Further care:

- Referral to dermatologist

- Referral to allergist

- Follow-up in ‍ ‍weeksmonths

- Return if pruritus worsens, if new symptoms develop, or if condition does not improve with treatment