48 year female came to opd with rash

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48 year old female house wife by occupation resident of west Bengal came to opd with 

CC  

     ----Rashes on arms and legs since 6 years 

    ---- Back pain since 15 years 

  History of presenting illness:-

 ----Patient was apparently asymptomatic 15 years ago then she developed backpain from cervical region extending upto lumbar region in the midline which is sudden in onset  aggravated on doing work and relieved on rest  for which she went to local hospital and was prescribed tab Fluoxetine  and some physiotherapy 

---- history of rashes on upper and lower limb  since 6 years which is insidious in onset slowly progressive with no itching 

    The rash is associated with itching since 3 months  more during night 

 Past history :-

--History of hypertension since 8 years and she is using telmisartan and amlodipine

--- history of thyroid problem  since 2008 for which she went to hospital and investigatios were done and diagnosed as hypothyroidism and  she is using Tab : thyroxine  100mcg

---- no history of asthma tuberculosis diabetes epilepsy 

Personal History:- 

     Diet - Mixed 

     Sleep - Inadequate 

      Appetite - normal 

     B&B - regular 

      No addictions .

 

Family history :-- not significant

Treatment history :-

    Thyroxine 100 mcg since 2008

   Telmisartan since 8years 

General examination

 Patient is conscious coherent and cooperative well oriented to time place and person moderately built and nourished

No pallor 

No icterus,

No cyanosis, 

No clubbing,

No  lymphadenopathy, 

No edema.

Vitals 

  BP:-120/80mm hg

  PR:- 78bpm

 RR :- 16cpm

 Temp :- afebrile 

  

 Local examination :-

  

Few exconations noted over the right and left hand  and legs 

Multiple hyperpigmented macules over the upper and lower limbs and abdomen 

Provisional diagnosis:-

  Prurigo simplex and back pain under evaluation