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Pruritus Investigation — SCE Dermatology MCQ

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EasyInflammatory DermatosesPruritus InvestigationSCE Dermatology

A 40-year-old man is being investigated for widespread pruritus without a primary skin rash. His dermatologist orders a comprehensive 'itch screen'. What investigations are recommended?

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Correct answer: AFBC, ferritin, LFTs, TFTs, renal function, glucose/HbA1c, CRP/ESR, calcium, LDH, CXR, and age-appropriate cancer screening

The correct answer is A, a broad systemic itch screen comprising FBC, ferritin, LFTs, TFTs, renal function, glucose/HbA1c, CRP/ESR, calcium, LDH, CXR, and age-appropriate cancer screening. Generalised pruritus without a visible primary rash is frequently a cutaneous sign of underlying systemic disease (haematological, renal, hepatic, endocrine or malignant), so UK dermatology guidance recommends a structured screen rather than a single test. FBC and ferritin detect iron deficiency and haematological disease, LFTs identify cholestasis, renal function detects uraemic pruritus, TFTs identify thyroid dysfunction, LDH and ESR/CRP raise suspicion of lymphoma, calcium screens for hyperparathyroidism or malignancy, and a CXR helps exclude bronchial carcinoma or lymphoma, with age-appropriate cancer screening reflecting the recognised association between new-onset generalised pruritus and occult malignancy. This comprehensive but targeted approach is the standard recommended by UK primary care dermatology guidance.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/skin-conditions