11th August 2020

A 30-year-old teacher presents to her GP complaining of generalised itching that is worse after a hot bath

A 30-year-old teacher presents to her GP complaining of generalised itching that is worse after a hot bath. On examination you notice her palms appear to be quite flushed and red. She also mentions having an increasing frequency of headaches. She has a history of migraines and takes sumitriptan, however she describes these headaches as being different in nature and more frequent, without any obvious triggers. She has no disturbance in her vision. She mentioned having one episode of sudden chest pain which she put down to anxiety whilst at work. She is otherwise well.

On examination you notice scratch marks over her arms, shoulders and torso and note she has a slightly tender abdomen over the epigastric region. She has no previous history of acid reflux and takes no other regular medication. She is a non-smoker, teetotal and has never used recreational drugs. Her mother had breast cancer at the age of 65 and passed away last year, with no other social or family history of note.

For the patient above, please select the SINGLE most likely diagnosis of the dermatological manifestation of their systemic condition/disease. Select ONE option from the list above.