Presenting Complaints

• Severe, generalized itching for the past 2 weeks

History of Presenting Complaint

• The patient reports that the itching started gradually about 2 weeks ago, initially on her arms and legs, and has since spread to her entire body.
• The itching is described as intense, constant, and worse at night, often keeping her awake.
• She denies any rash, hives, or visible skin changes, but notes that scratching provides temporary relief.
• She has tried over-the-counter hydrocortisone creams and antihistamines, but they have provided minimal improvement.
• She reports no recent changes in soaps, detergents, or other personal care products.
• She denies any fever, chills, weight loss, or other systemic symptoms.

Significant Positives & Negatives For Differentials

Scabies

Positives:

• Intense, generalized itching, especially at night

Negatives:

• No reported rash or burrows
• No history of exposure to scabies

Urticaria (Hives)

Positives:

• Intense, generalized itching

Negatives:

• No reported sudden appearance of raised, itchy welts

Systemic Condition (e.g., Thyroid Disorder, Liver Disease)

Positives:

• Generalized, intense itching

Negatives:

• No reported weight loss, fever, chills, or other systemic symptoms

Infection (e.g., Fungal, Bacterial)

Positives:

• Generalized, intense itching

Negatives:

• No visible rash or skin changes
• No reported fever or other signs of infection

Past Medical History

• Unremarkable, no prior skin conditions or allergies

Drug/Medication History

• No regular medications
• Tried over-the-counter hydrocortisone cream and oral antihistamines for the itching

Social History

• Works as an office administrator
• Lives with her husband in a single-family home
• Denies any recent travel or exposure to new environments

Family History

• No family history of skin conditions or allergies

Systems Review

• Positive for generalized itching
• Negative for rash, hives, fever, chills, weight loss, or other systemic symptoms

Ideas, Concerns & Expectations

• The patient is concerned that she may have developed a new skin condition or allergy, and is hoping the doctor can provide a diagnosis and effective treatment to relieve her symptoms.

Case Presentation

Based on the information provided, the most likely diagnosis is contact dermatitis or atopic dermatitis. The patient's lack of visible skin changes, history of trying over-the-counter treatments with minimal improvement, and absence of other systemic symptoms make scabies, urticaria, and systemic conditions less likely. While an infection cannot be completely ruled out, the lack of visible skin changes or signs of infection makes this a less probable diagnosis.