Itching- Case Scenarios Tom Gamble ST2 Group 20/4/11 Itching- Case Scenarios Tom Gamble

Case 1 – NH, 7 yr male Nick Heyward is a 7 year old boy who comes in with his mother. She tells you that he has had trouble sleeping for the last 2 weeks because he has been itching, and this seems worse at night. On examining him he has generally dry skin, with some redness around his flexures, and quite a few macules over his trunk and limbs. What questions might you ask? How would you treat him?

Case 1 Differential diagnosis: Atopic eczema Scabies Contact allergy Psoriasis

Case 2 – CH, 25 yr female Chrissie Hyde, a 25 yr old female comes to see you with an itchy rash on the ventral surface of her wrists and her lower back. What is the diagnosis? How would you treat it?

Lichen Planus Poorly understood aetiology -?immune mediated –sometimes in response to virus or drug Flat topped ‘violacious’ firm papules from pinpoint size to >1cm Commonly affects: flexural surfaces wrists/ arms/legs; trunk /thighs; mucous membranes Common in age 30-60 Resolve spontaneously after about a year, leave grey/brown markings Difficult to treat, potent steroids may help

Case 3 – MF, 17 yr male Martin Fry is a 17 year old boy who turns up at the surgery with an itchy rash which appeared over his torso What might you ask? What is the diagnosis? How would you treat it?

Pityriasis Rosea Thought to be caused by human herpes virus 7 Most common in children and young adults Herald lesion 2-10cm in size, limbs or trunk Days to weeks later multiple secondary lesions appear on trunk, follow Langer’s lines (Christmas tree pattern), salmon coloured Mild to moderate itching Resolves after 1-2 months, treat with anti-histamines/calamine.

Case 4 –SF, 48 yr female Siobhan Fahey, a 48 yr old woman who is fit and well apart from vitiligo, says she has been itching all over for the last 2 weeks. She has noticed a rash on her arms, but when you examine it all you can see are excoriation marks. What other examination might you do? How would you investigate or treat this presentation?

Itching Without Rash Differential diagnosis: Investigations: Urticaria Jaundice Iron deficiency anaemia Diabetes Hypo/hyperthyroidism Renal failure Prickly heat Leukaemia and myeloproliferative disorders Simple pruritis (no cause found) or psychogenic Investigations: FBC, U&E, TFT, LFTs, glucose