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There was no associated rash, and the itching had increased in severity during a few months. He had undergone treatment with emollients, topical corticosteroids, and oral antihistamines, without much benefit.
His medical history included ischemic heart disease, asbestosis, and peripheral vascular disease, for which he was taking simvastatin, furosemide, and clopidogrel hydrogen sulfate.
Treatment with each medication had been stopped for at least 3 months to ascertain whether this would relieve the itching, without any change. There was no personal or family history of atopy. Physical examination revealed no abnormality in the skin.
He was examined using routine hematologic complete blood cell count and biochemical tests liver function tests and serum urea nitrogen and electrolyte profiles, the results of which were all normal. His serum creatinine level was marginally elevated at 1.
Chest x-ray films showed pleural plaques in both hemithoraces that were suggestive of asbestosis; they were confirmed by computed tomography of the chest and by a restrictive pattern on spirometry.
Although the iron level normalized within 8 weeks, there was no improvement in the itching. Sedative antihistamine therapy 50 mg of hydroxyzine hydrochloride at bedtime and nonsedative antihistamine therapy 180 mg of fexofenadine hydrochloride once daily also conferred no benefit.
A course of broadband UV-B treatment was started, but the patient could not tolerate it because of increased itching within 2 hours of each phototherapy session. Case 2 A 72-year-old man had a 2-year history of generalized itching unassociated with rash.
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