Dermatology Question 22

A 53-year-old man is evaluated for itching lasting 5 months. He reports that his whole body is itchy and that a short course of emollients and antihistamine medication did not improve his symptoms. He feels well otherwise. Review of systems is negative including findings for fever, fatigue, and unintentional weight loss. He does not take any medications.

On physical examination, vital signs are normal. Examination of the skin reveals no signs of xerosis or inflammation. Excoriations are noted on his legs, shoulders, and back. The remainder of the physical examination, including thyroid and lymph node examinations, is normal.

A complete blood count, metabolic profile, serum thyroid-stimulating hormone level, liver chemistry tests, and HIV antibody assay are normal.

Which of the following is the most appropriate next step in management?

A Chest radiograph

B CT scan of the chest, abdomen, and pelvis

C Skin biopsy

D No further testing

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