Differential Diagnosis for Pregnant Women at 24 Weeks with Itching All Over
Single Most Likely Diagnosis
- Intrahepatic Cholestasis of Pregnancy (ICP): This condition is characterized by intense itching, particularly on the palms and soles, without a rash, and is often associated with elevated bile acids. It typically presents in the second or third trimester, making it a likely diagnosis for a woman at 24 weeks gestation.
Other Likely Diagnoses
- Pemphigoid Gestationis (PG): An autoimmune skin disorder that occurs during pregnancy, characterized by intense itching and blistering skin lesions. It usually starts around the navel and can spread to other parts of the body.
- Atopic Dermatitis (Eczema): Pregnant women with a history of atopic dermatitis may experience exacerbations during pregnancy, leading to widespread itching.
- Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP): Although PUPPP typically starts in the abdominal striae, it can spread and cause itching all over the body.
Do Not Miss Diagnoses
- Cholestasis due to other liver diseases (e.g., viral hepatitis, primary biliary cirrhosis): These conditions can cause itching and have significant implications for both mother and fetus if not promptly diagnosed and managed.
- Thyroid disorders: Both hyperthyroidism and hypothyroidism can cause itching, although it's less common. Given the potential impact on pregnancy, these conditions should not be missed.
- Drug reactions: Certain medications can cause itching as a side effect. Identifying and potentially changing the medication is crucial.
Rare Diagnoses
- Polycythemia Vera: A rare blood disorder that can cause itching due to histamine release, although it's uncommon in pregnancy.
- Lymphoma: Some types of lymphoma can cause itching, but this would be extremely rare in the context of pregnancy and widespread itching.
- Mastocytosis: A condition characterized by the accumulation of mast cells in the skin, which can cause itching, but it's very rare and not typically associated with pregnancy.