|Comments from Faculty and Members
Jerome Z Litt MD, Assistant Clinical Professor of
Dermatology, Case Western Reserve University School of Medicine,
Cleveland, OH, USA on September 29, 2007
This disorder is, I trow, comparable to Jean-Paul Marat's intractable
itching, during the French Revolution, where he was virtually
confined to a bathtub for about 4 years.
I wrote a small article about it 30 or so years ago and suggested
it might have been a variant of dermatitis herpetiformis.
Does anyone know if he routinely takes any medications? Vitamins?
Keep up the great site!
Rick Sontheimer MD, Professor and Vice-Chairman, Dept.
of Dermatology University of Oklahoma Health Sciences Center,
Oklahama City,OK, USA on September 29, 2007
Just to be on safe side I would first try an emperic trial
of ivermectin for occult scabies (two treatments 1 week apart).
What about his drug/supplement history? Then for subacute prurigo
I would push the daily dose of Dapsone up to 200 mg/d or hematologic
intolerance. Then I would go back to an extended trial of CellCept
at 3,000 mg/day (at least 3 months).
Khalid Hawsawi MD, Consultant Dermatologist and Head,
Department of Dermatology,King Abdul Aziz Hospital, Makkah,
Saudi Arabia on Oct 4, 2007
In addition to your differential diagnoses, there are three
very important diseases that should be ruled out. These are:
Lichen planus, scabies and atopic eczema. Presence of family
history support scabies and atopic eczema. Biopsy of a fresh
lesion may help in diagnosing lichen planus. Empirical treatment
of scabies may be warranted.
Davy Chan MD, Hong Kong, China on Oct 9, 2007
I can think about these two differentials: scabies and papular
urticaria. On the other side of the coin, should the patient
to see a psychiatrist, too ?
Frank Jonelis MD, Kaiser Hospital, San Francisco, CA,
USA on Oct 9, 2007
Other thoughts you probably have ruled out are - Multiple sclerosis,
Iron deficiency, internal malignancy and hepatobiliary disorder.
Azar Maluki MD, Asst Prof Derm and Ven, Kufa College
of Medicine, Najaf, Iraq on Oct 10, 2007
Strict sparing of certain areas over years with such type of
periodic itching makes scabies a very remote possibility. Involvement
of the brother can raise diagnosis of atopic diathesis especially
in advanced age where dry skin is a strong contributory factor.
I would treat such case by heavy topical lubrication with suitable
doses of tranquilizers. Sometimes controlled doses of oral immuran
could be helpful.