History of the Present Illness

The patient reports that he cannot remember when the rash began exactly. "Itching isn't the right word," he laments. The sensation is "impossible to articulate."

The patient denies recent exposure to persons with similar rashes. He reports that he has not been out much lately. He eats mostly frozen meals, a custom he developed after his wife of thirty-one years died last April (complications of pneumonia). He denies recent upper respiratory infections. The patient also denies taking excessively hot showers. He does enjoy hot showers, but his water heater "hasn't been doing so well." He denies recent visits to nursing homes, although he did see an advertisement for a chess group at the Brockton Senior Center in the newspaper yesterday. He used to play chess, but the recent worsening of his Parkinsonian tremor has led to his quitting this hobby, and he reports it is unlikely he will sign up to play. Transportation has also been difficult for him since he "hung up the keys," made worse recently by his daughter's moving to San Diego.

The patient describes the sensation as localized to his back and lower legs, though sometimes he finds a few bumps (which he thinks may be bug bites) on his forearms. He does not think that he has recently come into contact with poison ivy (he used to love gardening, but since his fall in June he has not been spending much time outdoors). He is unsure whether he has recently started any new medications, but knows that he takes "more than [he'd] like to." "I don't really keep up with the chores as much as I should," he states, and denies new soaps or cleaning products. He previously had a dog (Fitzy), but does not currently have pets.

He has tried treating his condition with "everything [he] can think of," including ketoconazole 2% cream (which he was previously prescribed for tinea pedis) and clobetasol 0.05% ointment (he reports that there was still a half-full tube in the bathroom cabinet that his wife previously used to treat her eczema). Neither has brought noticeable improvement.

The patient presents for evaluation and management.