Endless itch

Question 1

History of itch

Answer 1

what came first rash or itch - if itch more likely systemic, neuropathic, psychogenic cause 
timing and distribution of itch
specific areas or all over
DH - any causes
SH 
focused SI
any fevers - travel history

Question 2

pruritus

Answer 2

itching without a rash

Question 3

prurigo

Answer 3

intensely itchy papules and nodules

Question 4

chronic pruritus

Answer 4

itching >6 weeks

can lead to secondary skin lesions including, excoriations, lichenification and hyper pigmentation

Question 5

non skin causes of widespread rash

Answer 5

psychogenic - parasitophobia, OCD, depression, anxiety
neurological - peripheral neuropathy, MS, post herpetic neuropathy
thyroid - hyper thyroid
CKD
DM
GI - cholestasis
malignancy and haematological - Hodgkins lymphoma, myeloid and lymphatic leukaemia, solid malignant tumours, polycythaemia rubra vera,
multisystem: inflammation, infection - dermatomyositis, scleroderma, HIV, Hep C

Drugs

Question 6

examination in wide spread itch

Answer 6

nails and hair: clubbing (IBD, liver cirrhosis, congenital heart disease), splinter haemorrhages, palmar erythema, nail fold telangiectasia, loss of hair or hirsutism
GI: hepatomegaly, splenomegaly, abdominal masses
CVS: murmur
Resp: abnormal breath sounds
haematological: lymphadenopathy
neurological: limb weakness, facial asymmetry, cognition

Question 7

investigations in wide spread itch

Answer 7

ESR
FBC
TFT
U&Es
HIV serology
random glucose
CXR
serum immunoglobulins and electrophoresis