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These are people who itch but have no rash. The most common cause of itch is dry skin (especially in the elderly), so address this first.
Instructions for dry/itchy skin:
| • | change soap to unscented Dove |
| • | use Cetaphil cream moisturizer on damp skin after the shower |
| • | follow the "two-minute rule" = the moisturizer must be on the skin within two minutes of getting out of the shower or else the water evaporates and you lock in "nothing" |
If itch persists you may consider other etiologies (mechanism is in parenthesis) :
| • | primary biliary cirrhosis (accumulation of bile salts)
*(characteristic lab findings = increased alk. phosphatase, (+) anti-mitochondrial antibodies) |
| • | other hepatic disorders: hepatitis, extrahepatic biliary obstruction |
| • | hypothyroid (secondary to dry skin) |
| • | Hodgkin’s = most common malignancy associated with itching |
| • | confers a worse prognosis in both |
Always think about and look for itchy dermatoses as well scabies, dermatitis herpetiformis, lichen planus:
AND check for dermatographism if it is present, that is your answer and you can treat with Zyrtec 10 to 40mg/ day
lab tests –
| • | CBC – infection, malignancy, hemolytic anemia, polycythemia vera, hypersensitivity (eosinophils) |
| • | LFT’s – primary biliary cirrhosis, other biliary disease |
| • | chem 7 – uremia, diabetes |
| • | chest x-ray and lymph node exam – Hodgkin’s disease |
treatment: UVB is very effective for most etiologies
| • | pearl: with end-stage renal disease - pruritis is more common with ACE inhibitors and less common with furosemide |
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