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

2. 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?

3. Case 1 Differential diagnosis: Atopic eczema Scabies Contact allergy
Psoriasis

4. 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?

5. 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

6. 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?

7. 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.

8. 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?

9. 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