MKSAP: 59-year-old man with intermittent itching

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 59-year-old man is evaluated for a 3-month history of intermittent itching on the forearms. He describes the itch as deep, with a burning or tingling sensation. Scratching helps somewhat, but over-the-counter topical corticosteroids have not helped. Cooling the skin soothes the itch. He did not notice a rash until he started scratching. The itch gets worse after being in the sun, but sun exposure does not cause redness or a rash. On physical examination, the patient shows evidence of chronic sun damage on sun-exposed skin, including hyperpigmentation and solar lentigines. A few excoriations are present on the forearms, but no significant dermatitis is observed. The patient’s sensation on the arms and forearms is normal. Deep tendon reflexes are normal in the biceps, triceps, and brachioradialis. Which of the following is the most likely diagnosis? A: Brachioradial pruritus B: Polymorphous light eruption C: Prurigo nodularis D: Solar urticaria Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Dermatology Source Type: blogs