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Christopher Palmer
Christopher Palmer,
Category: Medical
Satisfied Customers: 87
Experience:  Hospitalist Physcian (Internist) at Kent County Hospital
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I have had this issue couple of months now: in late November

Customer Question

Hello. I have had this issue for a couple of months now: in late November I almost suddenly (1-2 nights) having itching all over my body: scalp, hands, fingers, feet, back and some front. I also developed eczema (tiny watery blisters) all over my hands/fingers and palms. It seemed to be more at night just before bed and possibly a time when it was colder outside and more dry inside. However, this was more severe itching than I had ever experienced. It was also at a time of extreme stress and anxiety for me related to work and economics, and personal (lost girlfriend, loneliness etc.): In fact, almost all of 2015 was a spectacular nightmare.Anyhow. In November I got some anti-histamines from my doctor (singulair, hydrozyxine, and one other I can't remember): about 1 month supply or so. I took them and they worked. Then ran out of all but the Hydroxyzine. I stopped all over the holidays (between Christmas and New Years) for a couple of days and felt fine, but then I got anxiety again and had the itching, so I went back on the Hydroxyzine (it's the only one I had any left of). I took it until earlier this week (3-4 das ago). I asked my doctor if I still needed it and she said I could go off it, so I did. Again, I was fine for 3 days or so but last night and today I have had the itching again: scalp, eyes, hands and feet. It's not as bad as it was before and I have not gotten the eczema. I've tried to mentally relax and not get too stressed over work (last night I had an anxiety attack as well) which I think has helped.... but I still feel the underlying itch as if it's just nuder the surface and can spring at any time again if I get stressed... and I have sort of been having anxious feelings today and that feeling in my heart of anxiety.
(I also had a hemorrhoid banded earlier this week on Tuesday and some perineum discomfort for the week before that - though those don't seem to be related I hope - I am scheduled to have a prostate exam though. in 2015 I had chest and abdominal CT scans, X rays, upper endoscopy and colonoscopies that only showed very mild fatty liver, gastristis, hemorrhids and a little esophagous inflammation but with negative biopsies for Barrett's and H. pylori - also thoracic spondylosis and the CT said "mesenteric lymph nodes of unknown significance". - basically doctors said everything seems pretty normal for me - I am 38, white male). I have a history of asthma, allergies and sensitivity to dry skin.What do you think? Could this be some kind of worse underlying issue like a leukemia or lymphoma or something? 2 doctors I have asked on here and my doctor don't think so.
What advice would you give in general?
Submitted: 10 months ago.
Category: Medical
Expert:  Christopher Palmer replied 10 months ago.

I would recommend seeing an allergist and possibly seeing a hematologist if you want better opinions regarding your itching and mesenteric lymph nodes. They would be able to do their own set of bloodwork. But given the fact that your year was terrible, it's very common to manifest anxiety as itching. Hydroxyzine is a very good anti-itching medication but also great for anxiety. Which might be why it help to you. If these specialists clear you then maybe talking to someone like a psychiatrist about this might help too. There are many reasons for someone to have itching, like you said something autoimmune or malignancy versus anxiety or allergy. From what everything they did so far, it sounds like a very good work up has been done. I think overall you should be reassured.

Customer: replied 10 months ago.
Thanks. I have followed up with my doctor so she is aware. I have an appointment on Feb. 1 but maybe I need one sooner?I know I do have a lot of anxiety. For some reason it gets worse in the evening within an hour or two before I go to bed (and I always have trouble getting to sleep) and when I wake up in the morning (often I dread getting up and what the day might hold). For example, last night for about 2 hours I itched all over - scalp and legs mostly, some arms. My legs were so bad that my theighs were red with hives, deep red. Eventually it slowly got better enough for me to sleep. Then I woke up maybe an hour later and felt fine - absolutely no itching or anything (did the sleep help me relax and anxiety go away?). Then this morning when I woke up, I felt fine, but when I stepped out of bed and got up and around, the itching started agani on my scalp and a little on my hands. I have a humidity meter I got from Lowe's hardware and it said the humidity indoors got down to 29 %. Could this be a combination of anxiety and dry air? ie: when I cover up and go to sleep it seems to get better. when I then expose my skin to the air and wake up, I itch. All of this also started in late November when our winter cold season started. The on call doctor I called last night also thought this time it might also be "rebound histamine" since I stopped taking my Hydrozyzine on Monday after taking it for about 2 months. Although, this all started in November when I wasn't on any antihistamines (and it's why I took them for a month or two), and when I went off of them for a couple of days over the holidays the itching started to come back (so I got myself back on the Hydroxyzine).Thoughts?
Expert:  Christopher Palmer replied 10 months ago.

Yes that can absolutely happen with taking antihistamines. When you come off of them, the histamines are no longer inhibited and thus the rebound effect. But the underlying cause is what needs to be addressed. Anxiety it obviously a large component of this after reading about the hives/itching going away when you are relaxed and after sleep in the am. But I would first see an allergist, then psychiatrist next. You need an alternative medication to treat the anxiety and see if the itching/hives subsides. Dry air can lead to dry itchy skin, that's possibly, but not hives. My thoughts in summary is that this is most likely anxiety provoked itching (pruritis) leading to increased blood histamine levels. This is actually not too uncommon. But reassure yourself it is unlikely anything serious such as cancer or autoimmune.

Customer: replied 10 months ago.
Thanks. If it were cancer (lymphoma or leukemia, or brain tumor), would the hydroxazine have helped, or would it go away when asleep or relaxed?
Expert:  Christopher Palmer replied 10 months ago.

You would very likely have neurologic symptoms if the brain was involved. Also, blood work would unlikely be normal if you had leukemia or lymphoma. Medications such as SSRI medications, SNRI or medications like Gabapentin may offer help with anxiety and itching. If cancer was involved, yes meds like hydroxyzine could possibly help, but anxiety is such a large component here and you've had an extensive workup. I would still see an allergist and certainly psychiatry. They will offer more reassurance because I'm sure they see this (itching/anxiety) even more often than an general internist.

Expert:  Christopher Palmer replied 10 months ago.

I hope this helps you. I really wouldn't worry about cancer right now. Just seems very unlikely after the tests/imaging that have been done.

Customer: replied 10 months ago.
Thanks. I have not had blood work in a year or so as far as CBC or anything. When I see my doctor next I might ask for one. It's tempting to ask for a head MRI but I doubt she'll approve that (though I have friends at a major NMR and MRI research lab where I use to work, I could hit them up :) ).Will keep you updated as I get more info, progress etc.
Customer: replied 10 months ago.
Also most of the imaging and other workup was 6-9 months ago around the time I also had hernia surgery.
Expert:  Christopher Palmer replied 10 months ago.

You sound very attuned to your body. Just keep on the lookout for other problems you might be experiencing. Although I don't expect anything else to happen. But again please follow up with an allergist and a psychiatrist. We definitely need control of your anxiety. Please keep me updated. Take care.

Customer: replied 10 months ago.
Thanks. What other problems are you suggesting I keep an eye (or other anatomical feature) on, and what might they suggest (or their absence suggest against)?I agree I need to work on my anxiety somehow. A new girlfriend and money would help but those are two of the most impossible things to acquire on earth.
Expert:  Christopher Palmer replied 10 months ago.

Things such as weight loss, soaking nite sweats, fever, blood in stool. Those are the main ones.

Customer: replied 10 months ago.
Definitely don't have weight loss! No night sweats that I am aware of (though all the itching when I try to go to bed makes it hard to tell at those times per se). No fever (though been sneezing some along with the itching - I assume sneezing is from the dry air). Blood in stool: not that I notice. I had a hemorrhoid banded recently (last week). in spring 2015 (last year, about 9 months ago) they found "occult blood" in 3 stool samples but I had a colonoscopy, upper endoscopy, and chest and abdominal CT scans which didn't show anything that would cause blood in stool except the hemorrhoids. The CT did say "mesenteric nymph nodes of unknown significance" but the doctors and radiologost all gave me an overall analysis that nothing they saw was concerning.
Expert:  Christopher Palmer replied 10 months ago.

Sounds like a very thorough workup. You should feel reassurance based on whats been done.

Customer: replied 10 months ago.
I'm reading these sites now. Seem intriguing, I may try some of these therapies for anxiety:https://umm.edu/health/medical/altmed/condition/eczemahttps://en.wikipedia.org/wiki/Autogenic_traininghttps://en.wikipedia.org/wiki/Cognitive_behavioral_therapy
Expert:  Christopher Palmer replied 10 months ago.

Certainly good to do some research on your own as well. CBTherapy is something a psychiatrist could do if they specialize in it.

Customer: replied 9 months ago.
Update: I've been on Hydroxyzine for the past 2-3 months. A couple of times I went off and within 3 days or so the itching returned, but I thought maybe since it's winter and I was still stressed out from work and holidays, this was to be expected. Also, I thought maybe coming off an antihistamien cold turkey would cause a histamine resurgence? So I just stayed on. Last week it was nice and warm, and this week it's been nice and warm and humid and raining, so last week I thought I would try to ween myself off the Hydroxyzine - taking it Monday, Wednesdya and Friday only for a couple of weeks, then T and Th for a couple, then going off in March. However, I haven't taken it since Friday (it's Monday now) and today my itching seemed to slowly creep back like before - tingling in hands and feet, itching scalp and eyes to some degree etc... The hands tingling feel like they could turn to the Eczema at any time, but haven't yet. Any suggestions on this? I took the Hydroxyzine again tonight since it's Monday.... The interesting thing is that I think this all started in November when we had a week of weather a lot like this... it was cold and dry for some days, but then it warmed up and was rainy, and the itching got worse during the rainy time (also, it seems to get worse if I don't shower for a couple of days or so, as I haven't in the past 36 hours because I've been working a lot lately - could this be related?).
Still haven't had the blood cell count yet, but I think I will ask my doctor for it this week given that itching seems to return after going off the antihistamine for only a few days each time I have tried... My doctor doesn't like to do tests so I usually have to build a case to get her to do it.What do you think? Is this reason for concern about something more serious?