72 yo female with these itchy-burning lesions all over the body for 20+ years. Improvement, but not disappearance in spring- & summer months. Diabetes & AH, actually well controlled. No inflammatory bowel disease. GFR 78. Ideas?
Seem to be linear...burrowing? In a nursing home? Norwegian scabies?
Do scabies live in Norway?
I'm sure with the right benefits they could be convinced to move.
Any lesions in areas that she can't reach? Mid back?
This patient is picking her skin. It's important to take a mental health history, ask about anxiety, depression, and strategies to cope with stress. The skin heals with triamcinolone ointment and oral minocycline. However, failure to address the mental health issues will cause recurrence of skin lesions.
It looks like she's picking... Anxiety related or just habit?
Maybe try doxepin? It is an antidepressant but works while for chronic pruritus as well.
This is clearly Psychogenic Prurigo.
I would say picking at the skin, maybe nervous habit. I had an MD that diagnosed this one time several several years ago and I can not remember the name, but I do remember that he said it had a neurological component.
Scratched up Bed bug bites?? Although those increase in spring and summer
By "all over the body", means lesions also where she can not reach? if not, this is a psychogenic prurigo. If there are, probably we should run some test searching for atopic markers
Seems like the wrong age demographic, but meth use??
Naturopathic Specialist Student
It seems like nervous picking or scratching. She could be unaware of it until it's bleeding. Is she scratching at dry skin possibly?
I agree these are neurotic excoriation with scars. I agree with all the comments about addressing her itching and consider OCD doses of SSRI. Not a consideration here with a 20 year history but I have seen Hodgkins Disease present as generalized itching and prurigo, so I always ask for a thorough internal evaluation whenever it's been going on longer than a few months. Good luck, challenging!!
Prurigo - psychogenic/nodular
Steroid under occlusion, antihistamine, consider doxepin/amitryptilline or UVB
Thank you all. I agree that psychogenic factors play the main role here.
See more images on Figure 1, a free crowdsourced library of medical cases