Differential Diagnosis for "Hell's Itch"

• Single most likely diagnosis
  • Sunburn: Hell's itch is a colloquial term often used to describe the intense itching that can occur after a sunburn, particularly as it begins to heal. This condition is very common in individuals who have experienced significant sun exposure without adequate protection.
• Other Likely diagnoses
  • Insect bites or stings: Itching can also be caused by insect bites or stings, which might be referred to colloquially in a similar manner due to the intense discomfort they can cause.
  • Contact dermatitis: This is a type of inflammation of the skin that occurs when the skin comes into contact with an irritant or allergen, leading to itching, among other symptoms.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Phototoxic reactions: Certain medications can cause phototoxic reactions when exposed to sunlight, leading to severe skin reactions that might include itching. Missing this diagnosis could lead to prolonged suffering or worsening of the condition.
  • Bullous pemphigoid: An autoimmune disease that can cause itching and blistering of the skin. Although less common, it's crucial not to miss this diagnosis due to its potential for significant morbidity.
• Rare diagnoses
  • Polycythemia vera: A rare blood disorder that can cause itching due to the release of histamine from basophils. The itching is often worse after warm baths or showers.
  • Aquagenic pruritus: A rare condition characterized by intense itching without any visible skin lesions, triggered by contact with water. It's a diagnosis of exclusion and might be considered if other causes of itching have been ruled out.