Pruritus

Patient is 85-year-old female who comes in to evaluate her chronic itching complaint. This has begun approximately three years ago. It seems to occur when she moved into her new independent living apartment complex in November 2012. She states that prior to moving here she was living in Greeley, Colorado and did not have any itching at that time, but when she moved here the itching began. She states that it seems to occur every day and seems to be worse when she is not distracted and trying to fall asleep. It seems to change in locations and seems to feel better with cold cloth or cold shower. She also uses lotion daily. Currently, she uses Vaseline but she has used Cetaphil in the past and that seemed to be a better moisturizer for her. She does state that her skin can be pretty dry. She does have some scalp itching too at the back of her head and a little bit of flaking.

She denies any problems with seasonal allergies and never had any problems with this. She does have a little decreased smell and decreased taste which could be due to an old age as she has not had any problems with sinus infection, chronic nasal congestion, or frequent infection. She has had some eye itching and eyelid irritation some of the time.

She denies any history of asthma, wheezing or lung problems. She has never had any allergic skin problems and has never evaluated for allergy before.

She has tried topical steroid ointment as well as topical Benadryl gel and they do seem to help relieve her itch for some time, although it has never seemed to resolve in the last three years.

ASSESSMENT:
1. Lichen simplex chronicus.
2. Possible seborrheic dermatitis.
3. Pruritus.
4. Cardiovascular disease.

PLAN:
1. At this time, she has tried steroid ointments that seemed to help but she has not used any systemic antihistamines to help her itch. I would like to start her on Zyrtec 10 mg daily to see if continuous use of this plus good skin hydration program will help relieve her symptoms. I encouraged her to use Cetaphil cream and Olivamine cream daily after lukewarm shower and to pat dry and to do this every day to better give her skin a good barrier as she appears to be dry today.
2. She has had some recent lab works done that are stated by the patient to be within normal limits, so I do not feel that it is due to any liver or kidney function problem. She has not started any other medications that seemed to be associated with this as well.
3. We will follow up in one month’s time to see how the skin hydration and Zyrtec daily has helped with her itching.

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