Differential Diagnosis for Cyclical Itching

The patient presents with cyclical itching all over the body, exacerbated during the menstrual cycle, despite having an IUD and not experiencing actual periods. The symptoms include intense itching episodes, hot flashes, increased body temperature, dry hands, menstrual cramps, and breast tenderness, without any visible rash.

• Single Most Likely Diagnosis

  • Hormonal Imbalance: The cyclical nature of the itching, coinciding with the menstrual cycle, and the presence of other symptoms like hot flashes, breast tenderness, and menstrual cramps, suggest a hormonal component. The fact that the patient has an IUD and does not have actual periods but still experiences these symptoms points towards a hormonal influence that is not solely dependent on the menstrual cycle itself but possibly on the fluctuations of hormones like estrogen and progesterone.

• Other Likely Diagnoses

  • Atopic Dermatitis (Eczema): Although the patient reports no visible rash, atopic dermatitis can sometimes present with minimal visible changes, especially if the patient is scratching frequently. The dry hands could be a manifestation of eczema.
  • Dry Skin (Xerosis): The symptom of dry hands and the relief from cold water could suggest that dry skin is a contributing factor to the itching.
  • Polycystic Ovary Syndrome (PCOS): Given the hormonal symptoms and the cyclical nature of the itching, PCOS could be a consideration, especially if other criteria for PCOS are met (e.g., irregular periods before the IUD, signs of hyperandrogenism).

• Do Not Miss Diagnoses

  • Thyroid Disorders: Both hypothyroidism and hyperthyroidism can cause itching and skin changes. The increased body temperature could also be a clue towards hyperthyroidism.
  • Hepatic Disorders: Certain liver diseases, like primary biliary cirrhosis, can cause itching without a rash. This would be an important diagnosis not to miss due to its potential for serious complications.
  • Malignancy: Although rare, some malignancies can cause itching as a paraneoplastic syndrome. This would be a diagnosis not to miss due to its severe implications.

• Rare Diagnoses

  • Brachioradial Pruritus: A condition characterized by intense itching on the arms, which could be considered if the itching is predominantly localized.
  • Notalgia Paresthetica: A condition causing itching on the back, which might be considered if the itching has a specific distribution.
  • Cholestasis of Pregnancy: Although the patient has an IUD and does not have actual periods, if there's any chance of pregnancy, this condition could cause intense itching due to bile duct obstruction. However, this would be extremely rare given the context.