[35F] With chronic itching and joint pain
Question
Family history of thyroid disorder
Patient Description
A 35-year-old female presents with chronic itching on her arms and legs, persisting for months. The itching is described as constant and is exacerbated by hot water, heat, sweat, and water. The patient experiences dry skin, goosebump-like eruptions on her arms, and tight skin with swelling around her ankles. The itching episodes occur daily, 4 to 5 times a day, lasting about 15 minutes or longer if scratching continues. The patient has tried Ketoconazole, eczema ointment, psoriasis ointment, anti-itch cream, and Selsun Blue with limited relief. Additionally, the patient reports firm swelling on her ankles, light brown patches on the top of both feet, joint pain and stiffness, particularly in the morning, and tenderness in the joints. There is a history of tendinitis in the right elbow. The patient has experienced weight gain, hair thinning, and loss. There is no history of autoimmune diseases or thyroid disorders, but there is a family history of diabetes. The patient quit smoking and heavy alcohol consumption last year. No recent travel or new medications or supplements have been reported.
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Arora's Assessment
What might be happening
Based on the symptoms you've described, here are some possible explanations:
Chronic Itching with White Patches
- Tinea Versicolor: This is a common fungal infection that can cause white or light-colored patches on the skin, often accompanied by itching. Ketoconazole is a common treatment for this condition.
- Eczema: Chronic itching and dry skin can be symptoms of eczema, which can also cause patches of discolored skin. Eczema can be exacerbated by heat, sweat, and water.
Swelling and Tight Skin on Legs
- Chronic Venous Insufficiency: This condition can cause swelling in the legs and ankles, especially after standing for long periods. It can also lead to skin changes, such as tightness and discoloration.
- Lymphedema: This is a condition where lymph fluid builds up in the tissues, causing swelling. It can be firm and is often accompanied by skin changes.
Joint Pain and Stiffness
- Osteoarthritis: This is a common condition that causes joint pain and stiffness, especially after periods of inactivity. It can also cause tenderness in the joints.
- Rheumatoid Arthritis: This autoimmune condition can cause joint pain, stiffness, and tenderness, particularly in the morning.
Light Brown Spots on Feet
- Hyperpigmentation: This can be caused by various factors, including sun exposure, inflammation, or certain medications. It is usually harmless but can be a cosmetic concern.
What you can do
Itching and White Patches
- Continue using Ketoconazole: Follow the instructions provided by your healthcare provider.
- Moisturize: Use a good quality moisturizer to keep your skin hydrated.
- Avoid Triggers: Try to avoid hot showers, excessive sweating, and other triggers that worsen your itching.
Swelling and Tight Skin on Legs
- Elevate Your Legs: When sitting or lying down, elevate your legs to help reduce swelling.
- Compression Stockings: Consider wearing compression stockings to help manage swelling.
- Stay Active: Gentle exercises like walking can help improve circulation.
Joint Pain and Stiffness
- Stay Active: Gentle exercises and stretching can help keep your joints flexible.
- Over-the-Counter Pain Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help manage pain and inflammation.
- Heat and Cold Therapy: Applying heat or cold packs to the affected joints can provide relief.
Light Brown Spots on Feet
- Monitor: Keep an eye on the spots for any changes in size, shape, or color.
- Sun Protection: Use sunscreen to protect your skin from further pigmentation changes.
What you should look out for
- Severe Swelling or Pain: If you experience severe swelling, pain, or redness in your legs, seek medical attention as it could indicate a more serious condition like a blood clot.
- Changes in Skin Patches: If the white or brown patches on your skin change in size, shape, or color, consult a healthcare provider.
- Worsening Joint Symptoms: If your joint pain and stiffness worsen or you experience new symptoms like fever or significant swelling, seek medical advice.
Remember, while I can provide information and suggestions, it's important to consult with a healthcare professional for a formal diagnosis and treatment plan. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.
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6 mo ago