indicate allergies. But antihistamines
didn’t get rid of the itching or the rash,
and topical steroid creams didn’t help,
either. Unable to sleep or stop scratch-
ing, let alone focus on work, Eva reluc-
tantly took a leave from her job.
Fourteen months after the itching
started, small, hard lumps, or skin
nodules, began appearing on Eva’s
arms, legs, back and buttocks. This
condition is called nodular prurigo,
and it sometimes develops after long-
term scratching. There are numerous
underlying conditions that can be
associated with it, including kidney
disease and anemia, but anxiety and
depression are also triggers. Since
Eva appeared physically healthy, her
doctor theorized that anxiety from the
initial bedbug bites may have led to
chronic, unstoppable itching.
Eva was referred to the dermatology
department at Geneva University Hos-
pitals, where a skin patch test was per-
formed to double-check for allergies.
“It’s non-invasive, and we try to elim-
inate simple environmental things
first, as it’s very easy to do,” says
Dr. Laurence Trellu, a senior physician
in the department who oversees
many of the complex cases. The test
was negative. Nodular prurigo often
responds to ultraviolet light therapy
or antidepressants, but in Eva’s case,
these weren’t effective.
The doctors didn’t give up on her. “In
many medical cases that are this chal-
lenging, the risk is that the physicianjust forgets it, and the patient is desper-
ate,” notes Trellu. “Many patients with
a chronic skin disease end up going
from one dermatologist to the next.”
She adds that especially when a
patient is young and previously healthy,
practitioners may assume the problem
will eventually resolve itself, and they
may even skip over aspects of a thor-
ough workup. But a systematic, step-
by-step approach is taken at her clinic,
and Eva felt believed and supported—
especially by the doctor she saw most
often, Dr. Marc Pechère.Eva still couldn’t sleep or go to
work, however. She tried whole-body
cryotherapy, enclosing herself in a
sub-zero chamber in a bid to stop the
itch. Cryotherapy is neither proven
nor completely safe—it can aggravate
a heart condition, for instance—and
while it provided Eva with some tem-
porary relief, it was no cure.
Six months later, Eva started feeling
pain around the skin nodules. She also
now had severe fatigue and nighttime
chills, which can sometimes signal an
internal disease. Eva’s family doctorEVA EXPERIENCED
SEVERE FATIGUE AND
NIGHTTIME CHILLS,
WHICH CAN SIGNAL AN
INTERNAL DISEASE.32 october 2019
reader’s digest