Presenting Complaints

• 44-year-old female patient presenting with a chief complaint of severe, generalized itching for the past 2 weeks.

History of Presenting Complaint

• The patient reports 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, significantly disrupting her sleep.
• She has noticed some redness and dryness of the affected areas, but no visible rash or hives.
• The patient has tried using over-the-counter hydrocortisone creams and antihistamines, but they have provided minimal relief.
• She denies any recent changes in soaps, detergents, or other personal care products.
• The patient reports no fever, chills, or other systemic symptoms.

Significant Positives & Negatives For Differentials

Contact Dermatitis

Positives:

• Generalized, intense itching
• Dry skin without visible rash
• No recent changes in soaps, detergents, or personal care products

Negatives:

• Lack of clear exposure to a new allergen or irritant

Atopic Dermatitis

Positives:

• Generalized, intense itching
• Dry skin without visible rash
• No history of allergies or skin conditions

Negatives:

• Onset in adulthood rather than childhood
• Lack of personal or family history of atopic conditions

Xerosis (Dry Skin)

Positives:

• Generalized, intense itching
• Dry skin without visible rash

Negatives:

• Lack of clear precipitating factors for severe dry skin
• Persistence and worsening of symptoms despite over-the-counter treatments

Scabies

Positives:

• Generalized, intense itching

Negatives:

• Lack of visible rash or burrows
• No known exposure to someone with scabies

Urticaria (Hives)

Positives:

• Generalized, intense itching

Negatives:

• Lack of visible hives or wheals
• No history of allergies or triggers for urticaria

Past Medical History

• Hypertension, well-controlled on lisinopril
• No history of allergies or skin conditions

Drug/Medication History

• Lisinopril 10 mg daily
• Occasional use of over-the-counter hydrocortisone cream and oral antihistamines for the current itching

Social History

• Works as an office manager
• Married with two children
• Denies tobacco, alcohol, or recreational drug use

Family History

• No family history of skin conditions or allergies

Systems Review

• Positive for generalized, intense itching and dry skin
• Negative for visible rash, fever, chills, or other systemic symptoms

Case Presentation

Based on the patient's history and the key positive and negative features for the differential diagnoses, the most likely diagnosis is a form of dermatitis, such as contact dermatitis or atopic dermatitis. The lack of a clear trigger or exposure, the generalized nature of the itching, and the lack of visible rash or hives suggest a non-specific inflammatory skin condition rather than a specific allergic or infectious process.