Generalised Pruritus — SCE Dermatology MCQ

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ModerateInflammatory DermatosesGeneralised PruritusSCE Dermatology

A 70-year-old woman develops widespread pruritus with no visible primary skin disease. She has normochromic normocytic anaemia and an elevated ESR. A peripheral blood film shows rouleaux formation. Serum protein electrophoresis reveals a monoclonal band. What haematological condition should be investigated?

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Correct answer: E — Multiple myeloma/monoclonal gammopathy

Generalised pruritus with a monoclonal band on serum electrophoresis, rouleaux formation, and elevated ESR should prompt investigation for multiple myeloma or monoclonal gammopathy. Pruritus occurs in approximately 5% of myeloma patients and may precede diagnosis. Other haematological malignancies causing pruritus include Hodgkin lymphoma (presenting with unexplained pruritus in up to 30%), polycythaemia vera (aquagenic pruritus), iron deficiency, and cutaneous T-cell lymphoma. Comprehensive investigation includes serum/urine protein electrophoresis with immunofixation, free light chains, skeletal survey, and bone marrow biopsy. Itch in the absence of primary skin disease always warrants systemic workup.

Reference: BAD 2020 Pruritus Guidelines; NICE Myeloma Pathway