Differential Diagnosis for Tingling and Generalized Itching in a 41-year-old Woman

Single Most Likely Diagnosis

• Dry Skin (Xerosis): This is a common condition that can cause generalized itching and tingling sensations, especially in dry environments or during winter months. It's often associated with a lack of moisture in the skin.

Other Likely Diagnoses

• Atopic Dermatitis (Eczema): A chronic skin condition characterized by itchy, inflamed skin. It can cause tingling sensations due to the intense itching and skin barrier disruption.
• Urticaria: Hives can cause itching and sometimes tingling sensations due to the release of histamine, leading to blood vessel dilation and increased skin sensitivity.
• Allergic Reactions: Allergies to substances like metals (e.g., nickel), soaps, or certain fabrics can lead to skin reactions that include itching and tingling.
• Hypothyroidism: Some patients with hypothyroidism may experience dry skin, itching, and tingling sensations due to metabolic changes and possible peripheral neuropathy.

Do Not Miss Diagnoses

• Multiple Myeloma: A type of blood cancer that can cause itching due to the release of substances that affect the skin. Tingling can also occur due to peripheral neuropathy, a known complication.
• Lymphoma: Certain types of lymphoma can cause itching (pruritus) without a rash, and neurological symptoms can include tingling due to nerve involvement.
• Cholestasis: Conditions affecting bile flow, like primary biliary cirrhosis, can cause severe itching without a rash. Tingling is less common but can occur due to associated vitamin deficiencies.
• Hypoparathyroidism: Rarely, this condition can cause tingling sensations due to low calcium levels affecting nerve function. Itching can also be present due to associated skin conditions.

Rare Diagnoses

• Brachioradial Pruritus: A condition characterized by intense itching and sometimes tingling on the arms, often related to nerve root irritation in the neck.
• Aquagenic Pruritus: A rare condition where contact with water induces itching without a rash. Tingling can be associated due to the intense sensory stimulation.
• Polycythemia Vera: A myeloproliferative disorder that can cause itching and tingling sensations, particularly after warm baths or showers, due to histamine release from increased basophils.
• Neurological Disorders (e.g., Neuropathies): Certain neuropathies can cause tingling and, less commonly, itching sensations due to nerve damage affecting sensory perception.