Patient: I am a 26 year old male. In early March of 2014, I came back from a work retreat in Mexico and had trouble sleeping. I would wake up at 2 and 3am with itching on my legs. The itching felt as if something was crawling on my legs. The itching continued to disturb my sleep significantly for weeks. Within a few weeks, I was feeling the itching not just in my legs but also on my arms, my chest, my back and my face. I only noticed the itching at night when I would lie down to sleep. I saw an internal medicine doctor who did a blood test and stool sample (for parasites) and confirmed that everything looked normal. He provided me with Hydroxyzine which helped a bit but did not work as well for me as Benadryl. I also saw a dermatologist who checked my full body. He did not find a rash and also could not find any evidence of scabies. He prescribed a moisturizing lotion for my legs as well as Permethrin. The symptoms continued through May until another internal medicine doctor prescribed me a 5 day course of Methylprednisolone.Following completion of the methylprednisolone, the itching slowly went away in the first week of May. I did not experience any symptoms until end of July this year. It was then that the itching started to come back. The same internal medicine physician gave me a 5 day course of methylprednisolone. This took the itching away for a few days but then it came back. I now can feel the itching intermittently during the day. I continue to wake up at 2, 3 or 4AM (sometimes multiple times throughout the night). I am exhausted the next morning.I saw another dermatologist who also could not find a rash, bumps, or any evidence of skin issues. I continued to work with my new PCP who took new blood tests and could find nothing out of the ordinary. We checked for thyroid issues, hepatitis, STDs, lymes disease, parasites, etc. All tests have come back negative. I also had a chest x-ray completed which had no signs of anything abnormal. My lymph nodes do not appear to be swollen. I have also seen a rheumatologist who checked for lupus (my younger brother has it) and celiac’s disease. I also saw a neurologist who mentioned Restless Legs Syndrome but said the symptoms usually just appear in the arms and legs (not the chest, back and face). I saw an allergist who checked me for allergies and indicated that I have none. My dad has multiple myeloma so I also visited his oncologist / hematologist. He tested me for blood disorders and all the tests came back normal.I have not changed laundry detergents and do not used scented soaps. I don’t take caffeine before bed time and sleep in a fully dark room. I haven’t experienced fever or night sweats, though one doctor did mention lymphoma as a possibility? My bed partner has experienced no symptoms. I also don’t feel much anxiety – the only thing that frustrates me is this lack of sleep from the itching.I am desperate to be able to sleep through the night (and ideally to be able to stop this itching). Do you have any idea of what this might be or who I should see next? Any thoughts on what I might take or do to stop the itching? Is it worth pushing for more advanced screening?Thank you very much for any help.Andrew
Symptoms: Whole-body itching
Doctor: Thank you for your question.The approach to date has been very comprehensive and there are no additional medical cau ses that need to ruled out.There are 2 important clues:You have whole body itchiness with no external rashYou responded well to an oral steroidThis strongly suggests an internal process that is triggering your immune system into overdrive.Once diseases such as lupus and inflammatory conditions have been ruled out, this leaves only the possibility of something you are ingesting that is causing these symptoms.The next best step would be to see a naturopath for food sensitivity testing and dietary cleanse. If yor symptoms resolve after a 1 to 2 week cleanse, it would strongly support the possibility of a dietary allergenI hope this was helpful.
Comments / Follow Ups
Patient: Thank you for your help. I will plan to consult a naturopath and try a dietary cleanse.
One other thought did come to mind: a week before this all started back in March of 2014, I used Mederma on my back to try to help with stretch marks. My back developed quite an intense rash which itched and burned for a few days. I’ve recently read online that Mederma’s active ingredient is Allium cepa, the common onion. Is it possible that this reaction to Mederma is somehow related to the itching I’ve been experiencing over the past 8 months? Could a strong allergic reaction to Mederma trigger new food and/or other allergies?
Thanks again for all your help!
Doctor: It is possible that it may have triggered a lasting onion allergy but it would not be possible to trigger an allergy to something not in the Mederma compound.