Dermatology: Generalized Itching Causes

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Questions and Answers

What is a common cause of generalized itching without an apparent rash?

Psoriasis

Atopic eczema

Dry skin (correct)

Acne

What is the primary goal of asking about the effect of topical or oral medications during history taking?

To identify the underlying cause of the rash

To evaluate the patient's overall health

To determine the severity of the rash

To assess the patient's response to treatment (correct)

What is the significance of asking about the impact of the rash on the individual's quality of life?

To identify the underlying cause of the rash

To understand the patient's psychological distress (correct)

To assess the patient's overall health

To determine the severity of the rash

Hair shedding at roots is commonly caused by what?

Telogen affluvium Signup and view all the answers

What is suggested by a history of asthma, hay fever, or childhood eczema?

Atopy Signup and view all the answers

What should be inquired about in a patient's family history?

History of atopy and skin conditions Signup and view all the answers

What increases the risk of melanoma by as much as 75%?

Use of indoor tanning beds, especially before age 35 years Signup and view all the answers

What should be assessed if a patient reports a new growth or concerning lesion?

Risk factors for melanoma Signup and view all the answers

What is associated with dermatitis herpetiformis?

Celiac disease Signup and view all the answers

Why is it important to ask about sun exposure?

To assess risk factors for actinic damage or photosensitive eruptions Signup and view all the answers

What is a risk factor for melanoma?

Light eye or skin color Signup and view all the answers

What is a common physical exam finding in individuals with a high risk of melanoma?

Freckles Signup and view all the answers

What is the purpose of performing a hair pull test?

To examine the hair for shedding from the roots Signup and view all the answers

What is the purpose of examining the scalp?

To inspect the scalp for erythema, scaling, and scarring Signup and view all the answers

What is a common method used to separate the hair to see the scalp?

Using a cotton-tipped applicator Signup and view all the answers

What is the purpose of performing a tug test?

To examine the hair for fragility Signup and view all the answers

What is the term for a flat spot that is larger than 1 cm?

Patch Signup and view all the answers

What is the characteristic of a papule?

Raised and smaller than or equal to 1 cm Signup and view all the answers

What is the term for a fluid-filled lesion that is smaller than or equal to 1 cm?

Vesicle Signup and view all the answers

What is the characteristic of a macule?

Flat and smaller than or equal to 1 cm Signup and view all the answers

What is the term for a flat spot that is smaller than or equal to 1 cm?

Macule Signup and view all the answers

What is the characteristic of a plaque?

Raised and larger than 1 cm Signup and view all the answers

What is the term for a fluid-filled lesion that is larger than 1 cm?

Bulla Signup and view all the answers

What is the characteristic of a patch?

Flat and larger than 1 cm Signup and view all the answers

What is the term used to describe a shape that is ring-like with a central clearing?

Annular Signup and view all the answers

What color is often used to describe a lesion that is the same shade as the patient's skin?

Skin-colored Signup and view all the answers

What is the term used to describe a lesion that temporarily lightens in color when pressed with a finger or glass slide?

Blanching Signup and view all the answers

What condition has greasy scaling?

Seborrheic Dermatitis Signup and view all the answers

What is the term used to describe the pattern of a skin lesion, such as linear or dermatomal?

Configuration Signup and view all the answers

What is the term used to describe a lesion that is characterized by a fine, keratotic scale?

Actinic keratoses Signup and view all the answers

What is the term used to describe a lesion that is characterized by a hard, keratotic scale?

Actinic keratoses or SCC Signup and view all the answers

Study Notes

Generalized Itching

Patients may experience generalized itching without a visible rash due to various underlying conditions, including:
- Dry skin
- Drug reactions
- Pregnancy
- Uremia
- Jaundice
- Thyroid disease
- Polycythemia vera
- Lymphomas and leukemia

History Taking

When taking a patient's history, ask about:
- Variations in symptoms over time (e.g., pruritus worsening at night)
- Preceding symptoms (e.g., sore throat in psoriasis)
- Aggravating or relieving factors (e.g., exercise, heat, or topical/oral medications)
- Associated constitutional symptoms (e.g., joint pain, muscle weakness, fever, fatigue, or weight loss)
- Impact of the rash on the patient's quality of life

Hair Loss

When assessing hair loss, ask about:
- Hair thinning or shedding
- Pattern of hair loss (e.g., diffuse, localized, or patchy)
- Hair care practices (e.g., frequency of shampooing, use of dyes, chemical relaxers, or heating appliances)
- Acuity of onset (e.g., sudden or gradual)
- Preceding severe illness or recent pregnancy

Past Medical and Medication History

Ask about:
- General health and previous medical or skin conditions
- History of asthma, hay fever, or childhood eczema (suggesting atopy)
- Celiac disease (associated with dermatitis herpetiformis)
- Full medication history, including recent oral or topical prescriptions or over-the-counter medications
- Allergies to medicines, food, or environmental factors

Inquire about:
- Occupation and hobbies (e.g., exposure to chemicals causing contact dermatitis)
- Foreign travel (considering tropical infections)
- Sun exposure (considering actinic damage or photosensitive eruptions)
- Tanning bed use (increasing risk of melanoma)
- Family history of atopy and skin conditions

Examining the Hair and Scalp

Examine the hair and scalp by:
- Separating the hair to inspect the scalp from one side to the other
- Noting the distribution, texture, and quantity of hair
- Inspecting the ears
- Performing a hair pull test to examine hair shedding from the roots
- Performing a tug test to examine hair fragility

Describing Skin Findings

Use descriptive terms to characterize skin lesions, including:
- Shape: circular, oval, annular, nummular, or polygonal
- Color: tan, light brown, dark brown, skin-colored, bright red, purple, or violaceous
- Blanching vs. non-blanching: redness that temporarily lightens or remains unchanged with pressure
- Texture: smooth, fleshy, verrucous, scaly, dry, or greasy
- Location: specific measurements from landmarks or anatomical features
- Configuration: linear, unilateral, dermatomal, grouped, or generalized patterns

Flat Spots

Characterize flat spots as:
- Macules: small (≤1 cm) and flat
- Patches: large (>1 cm) and flat

Raised Spots

Characterize raised spots as:
- Papules: small (≤1 cm) and raised
- Nodules or plaques: large (>1 cm) and raised
- Vesicles: small (≤1 cm) and fluid-filled
- Bullae: large (>1 cm) and fluid-filled

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Description

Identify the underlying causes of generalized itching in patients, including skin conditions, systemic diseases, and medication reactions. Learn to ask relevant questions during history taking to diagnose the root cause.