Diagnostic quiz: itchy, bumpy lesions
A 45-year-old male visits his nephrologist and presents symptoms of numerous bumpy lesions on his arms, legs and back. The lesions are extremely itchy, and the patient has been frustrated by the lack of sleep and level of burning and stinging from lesions that will not seem to heal and seem to be spreading to other parts of his body. The patient reports increased anxiety due to disrupted sleep patterns and intense cycles of severe itching. After an evaluation, the patient is found to have ~80 individual nodules. The patient is currently on treatment for chronic kidney disease (CKD), type 2 diabetes mellitus and hypertension. Even though the patient has successfully managed CKD with medication with few complications, he is worried that these lesions are related, and permanent, which has added to his anxiety.