A woman in her 50s presented to her primary care physician with itchiness that kept her from sleeping. She had no history of skin disease and took hydrochlorothiazide and paroxetine hydrochloride for hypertension and depression, respectively. The pruritus began 6 months prior but was becoming more frustrating. She had tried various over-the-counter creams, which had not helped. On examination, she was noted to have dry skin and scattered scabs. She was prescribed triamcinolone acetonide cream, a topical corticosteroid, for 2 weeks. At her return visit, she reported little improvement and was told that “some tests” were needed to evaluate whether her pruritus was due to “a cancer or disease inside her.” Records showed that a complete blood cell count with differential, liver function tests, basic metabolic panel, thyroid function tests, and hepatitis B, C, and human immunodeficiency virus testing, as well as a chest x-ray, were ordered. The chest x-ray showed indistinct areas of perihilar opacification, and a chest computed tomographic scan was recommended for further evaluation, whereas the other tests did not indicate any evidence of disease. The chest computed tomographic scan showed no masses or signs of disease. Because of her recalcitrant pruritus, she was referred to the dermatology clinic.
Smucker J, Portas L, Kirby JS. Overevaluating Chronic PruritusA Teachable Moment. JAMA Intern Med. 2015;175(6):895-896. doi:10.1001/jamainternmed.2015.1041