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What Causes Extremely Itchy, Dry Skin, Muscle Twitching, Chest Pressure And Lightheadedness?
Question: Hello. I'm getting some strange, disturbing symptoms the
last few weeks that might point to something serious.
I'm not sure they are all due to the same cause, but
they might be.
The symptoms are: extremely itchy, dry skin(all over). Often
occuring at the same time with muscle twitching(again, all
over). This happened a few months ago, and resolved itself
for a while. It came back about 4 days ago. The trigger(if
there was one) seemed to be extreme heat(I live in Arizona)
and stress(job related).
Another set of symptoms, that started
to appear about a month ago(EXACTLY at the time when temps
really started to rise around here) are chest pressure and lightheadedness,
and very slight shortness of breath.
Last week, the chest pressure/lightheadedness hit me real hard
after stepping out in the heat, and then going to a stressful
meeting at work. I went to the hospital ER. They ran 3 sets
of Troponine I tests and 3 separate EKG's over the course of
any overnight stay. ALL were normal. So I was definitely not
having a heart attack then. Earlier today, the same symptoms
came on rather hard again, so I called the paramedics. All vitals
were perfect, and they said I could go to the hospital if I wanted,
but they didn't seem super-worried about my heart. One of them
said it could be pleurisy. I was exposed to asbestos a little bit in
the Navy, so hearing things like that worries me.
I should mention I also have chronic acid reflux, which could be
responsible for at least some of these symptoms.
Tests I've had so far:
- the ER tests mentioned above
- they also ran liver and thryoid tests, which they say were all normal
- ultrasound of RUQ in ER last week. Perfectly normal
- chest XRay in ER last week, also normal
- the usual CBC blood tests(normal)
- back in January I had a lung CT scan, which was normal
except for some 'minimal scarring'. I had this test done because I was
pretty short of breath at the time(seemed to be triggered by the indoor
heat kicking in). They compared it to a previous one done about a year
ago, and it was 'unchanged', so no evidence of any disease process
- CT angiogram 3 years ago showed < 25% occlusion in right coronary artery,
otherwise normal. Cardiologist said that's a normal test result.
- had a Prothrombin Time test a few months ago, and it was 1 second
above normal. A repeat a week later showed it was high, but now
in the normal range.
At this point, I'm frustrated because I don't know what direction
to take to diagnose this. I'm sure I will need another cardiac workup.
But what if lung issues are causing some of this? Not only the chest
pressure, lightheadedness and shortness of breath, but someone
told me itchy skin could be a sign of lung problems.
Here are the possible causes of the itchy skin/muscle twitches:
- liver problems(or would a normal liver panel and ultrasound rule that out?)
- hypothyroid(maybe ruled out by normal TSH, but I hear there
are other thyroid tests one can take to truly rule this out,
like reverse TSH)
- lung disease(but wouldn't a normal CT scan 6 months ago
rule that out?)
- cancer
- lymphoma(but no swollen glands and a normal CBC)
- prostate(but just had a PSA 2 months ago which they said
was normal)
- chronic stress:
- having lots of job related stress the last 8 months or so
- having lots of anxiety over health problems
- the extreme heat here is a big stressor(this is my first summer in Arizona)
- having lots of sleep issues(ie lack of sleep)
- adrenal insufficiency
Given all that, what do you think might be going on,
and what tests do you recommend I take to find out?
Sorry for the huge amount of detail, but I feel this is necessary
to help you make an informed decision on which direction to
take from here.
Thanks so much,
XXXXXXX Pierce
last few weeks that might point to something serious.
I'm not sure they are all due to the same cause, but
they might be.
The symptoms are: extremely itchy, dry skin(all over). Often
occuring at the same time with muscle twitching(again, all
over). This happened a few months ago, and resolved itself
for a while. It came back about 4 days ago. The trigger(if
there was one) seemed to be extreme heat(I live in Arizona)
and stress(job related).
Another set of symptoms, that started
to appear about a month ago(EXACTLY at the time when temps
really started to rise around here) are chest pressure and lightheadedness,
and very slight shortness of breath.
Last week, the chest pressure/lightheadedness hit me real hard
after stepping out in the heat, and then going to a stressful
meeting at work. I went to the hospital ER. They ran 3 sets
of Troponine I tests and 3 separate EKG's over the course of
any overnight stay. ALL were normal. So I was definitely not
having a heart attack then. Earlier today, the same symptoms
came on rather hard again, so I called the paramedics. All vitals
were perfect, and they said I could go to the hospital if I wanted,
but they didn't seem super-worried about my heart. One of them
said it could be pleurisy. I was exposed to asbestos a little bit in
the Navy, so hearing things like that worries me.
I should mention I also have chronic acid reflux, which could be
responsible for at least some of these symptoms.
Tests I've had so far:
- the ER tests mentioned above
- they also ran liver and thryoid tests, which they say were all normal
- ultrasound of RUQ in ER last week. Perfectly normal
- chest XRay in ER last week, also normal
- the usual CBC blood tests(normal)
- back in January I had a lung CT scan, which was normal
except for some 'minimal scarring'. I had this test done because I was
pretty short of breath at the time(seemed to be triggered by the indoor
heat kicking in). They compared it to a previous one done about a year
ago, and it was 'unchanged', so no evidence of any disease process
- CT angiogram 3 years ago showed < 25% occlusion in right coronary artery,
otherwise normal. Cardiologist said that's a normal test result.
- had a Prothrombin Time test a few months ago, and it was 1 second
above normal. A repeat a week later showed it was high, but now
in the normal range.
At this point, I'm frustrated because I don't know what direction
to take to diagnose this. I'm sure I will need another cardiac workup.
But what if lung issues are causing some of this? Not only the chest
pressure, lightheadedness and shortness of breath, but someone
told me itchy skin could be a sign of lung problems.
Here are the possible causes of the itchy skin/muscle twitches:
- liver problems(or would a normal liver panel and ultrasound rule that out?)
- hypothyroid(maybe ruled out by normal TSH, but I hear there
are other thyroid tests one can take to truly rule this out,
like reverse TSH)
- lung disease(but wouldn't a normal CT scan 6 months ago
rule that out?)
- cancer
- lymphoma(but no swollen glands and a normal CBC)
- prostate(but just had a PSA 2 months ago which they said
was normal)
- chronic stress:
- having lots of job related stress the last 8 months or so
- having lots of anxiety over health problems
- the extreme heat here is a big stressor(this is my first summer in Arizona)
- having lots of sleep issues(ie lack of sleep)
- adrenal insufficiency
Given all that, what do you think might be going on,
and what tests do you recommend I take to find out?
Sorry for the huge amount of detail, but I feel this is necessary
to help you make an informed decision on which direction to
take from here.
Thanks so much,
XXXXXXX Pierce
Brief Answer:
need more information
Detailed Answer:
Dear,
Welcome to HCM
I can understand the amount of distress that you are through.
After going through the report and history, i could infer that there is no abnormalities related to heart, lungs and no grave issue either.
However your symptoms still continues to persist.
Considering on this information we need to reconsider the symptoms once again. For the same I would like to probe into more detail of your current complaints.
You have a better clinical picture, I may need to ask you a few more questions.you mentioned that you experience itching over all skin, breathlessness, muscle twitching, lightheadedness; the occurrence of these complains, ,
Is it episodic? Do they tend to occur abruptly? And how long do they last?
Is it triggered on sweating, exercise, bathing with hot water?
Is there lesions on skin?
do you have allergy issues before? asthma? urticaria?
Information related to these questions can help me to have a better clinical picture and required information. Kindly reply soon.
Regards
need more information
Detailed Answer:
Dear,
Welcome to HCM
I can understand the amount of distress that you are through.
After going through the report and history, i could infer that there is no abnormalities related to heart, lungs and no grave issue either.
However your symptoms still continues to persist.
Considering on this information we need to reconsider the symptoms once again. For the same I would like to probe into more detail of your current complaints.
You have a better clinical picture, I may need to ask you a few more questions.you mentioned that you experience itching over all skin, breathlessness, muscle twitching, lightheadedness; the occurrence of these complains, ,
Is it episodic? Do they tend to occur abruptly? And how long do they last?
Is it triggered on sweating, exercise, bathing with hot water?
Is there lesions on skin?
do you have allergy issues before? asthma? urticaria?
Information related to these questions can help me to have a better clinical picture and required information. Kindly reply soon.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
Hello Doctor.
Here's the information u requested
the itchy skin and muscle twitching is episodic. Heat is the main trigger for the itchy skin(eg. Taking a hot shower and the hot weather). Also stress I think. Stress seems to be the main trigger for the muscle twitching. Both symptoms are worse after lying down for a while. the itchy skin went away the first time after a few weeks of using cocoa butter after showering. It seems to be helping now too. The lightheadedness and chest pressure come on srparately. Heat and stress and acidic food seem to be the main triggers for this.
Here's the information u requested
the itchy skin and muscle twitching is episodic. Heat is the main trigger for the itchy skin(eg. Taking a hot shower and the hot weather). Also stress I think. Stress seems to be the main trigger for the muscle twitching. Both symptoms are worse after lying down for a while. the itchy skin went away the first time after a few weeks of using cocoa butter after showering. It seems to be helping now too. The lightheadedness and chest pressure come on srparately. Heat and stress and acidic food seem to be the main triggers for this.
Brief Answer:
suspecting cholinergic urticarial condition, more information needed
Detailed Answer:
Thanks for the reply.
Your information makes clear that heat and temperature I predominant triggering factor.
I would like to know what happen when you do exercise and start sweating.eg. working out on a tredmill or jogging?
Do you experience itch sometime during sleep at night?
Itch is more in winters?
suspecting cholinergic urticarial condition, more information needed
Detailed Answer:
Thanks for the reply.
Your information makes clear that heat and temperature I predominant triggering factor.
I would like to know what happen when you do exercise and start sweating.eg. working out on a tredmill or jogging?
Do you experience itch sometime during sleep at night?
Itch is more in winters?
Above answer was peer-reviewed by :
Dr. Raju A.T
Hi doctor,
Yes, the itching occurs at night, and is in fact
at it's worst then. Exercise and generally any
kind of activity seem to make it go away
temporarily. I usually don't work out hard
enough to work up a sweat, so I don't
know if it's linked to that. I looked up
the definition of 'cholinergic' and found
it is a response to acetylcholine, which,
I believe, is associated with increased
adrenaline/cortisol levels(ie. being
in a 'fight or flight' state). If I'm correct,
then this hypothesis does make sense
to me, because I've been under a great
deal of stress lately. And, I noticed the
twitching is strongly associated with
stress levels(eg. if I'm stressed during
the day, I'm more likely to have muscle
twitches that night).
So, do you think we can rule out the liver
as a likely cause, since my liver panel
was completely normal, and I had a normal
RUQ ultrasound?
Thanks again!
XXXXXXX
Yes, the itching occurs at night, and is in fact
at it's worst then. Exercise and generally any
kind of activity seem to make it go away
temporarily. I usually don't work out hard
enough to work up a sweat, so I don't
know if it's linked to that. I looked up
the definition of 'cholinergic' and found
it is a response to acetylcholine, which,
I believe, is associated with increased
adrenaline/cortisol levels(ie. being
in a 'fight or flight' state). If I'm correct,
then this hypothesis does make sense
to me, because I've been under a great
deal of stress lately. And, I noticed the
twitching is strongly associated with
stress levels(eg. if I'm stressed during
the day, I'm more likely to have muscle
twitches that night).
So, do you think we can rule out the liver
as a likely cause, since my liver panel
was completely normal, and I had a normal
RUQ ultrasound?
Thanks again!
XXXXXXX
Brief Answer:
Suggestive of cholinergic hypersensitivity
Detailed Answer:
Thanks for the information.
well, your information is consistent with cholinergic urticarial condition.
It is an hypersensitivity(allergic) state to an increased cholinergic State in the body.
Example. such as increased stress levels, sweating or exposure to hot temperature, spicy food, anxiety, etc.
There is tingling sensation with lesions on skin associated with intense bouts of itching. The condition is more severe during winters and more in person with dry skin issues.
The cause for such a condition is unknown it can happen to anyone and there is no specific etiology for it. Like any other allergic state.
The treatment is same as for any other common allergy, i.e.
1. Avoid the triggering factors. in your case avoid over clothing.
2. Avoid certain food stuffs that are high in serotonin content( the chemical that is responsible for production on acetylcholine). eg, capsicum, lady finger, brinjal, are you etc. For a detailed work up and information you can take help of dietician.
3. Avoid letting your skin remain dry. Application of moisturizer and skin lotion twice a day, one after bathing and one before sleep. Here you can avoid having bath with hot water, a XXXXXXX warm or cold water bathing is recommended.
4. For medication i would suggest an anti histaminic drug like Tab Hydroxyzine 25 mg one at bed time and tab certizine 5 mg one in the morning for 15 days. Being an idiopathic condition the condition should subside on its own within few weeks.
5. I would advice to keep the stress levels at minimum by avoiding over working, doing moderate exercise and adequate sleep. Avoid eating junk food.
6. For your muscle sore i suspect that it is due to the associated anxiety that is causing the problems. It should subside concurrently and no seperate intervention is needed as of now. In case it is severe and persist to continue then it is advisable to see a local physician.
For your other related concern since the investigations have come up to be normal there is no reason to be worried about other organic pathology. Your liver reports are normal and therefore nothing to worry at that.
For best results i still would recommend you to consult and discuss the above with your local dermatologist or visit a near allergy clinic.
Hope to have satisfied your query.
welcome for further suggestions.
Regards,
Dr Pankaj
Suggestive of cholinergic hypersensitivity
Detailed Answer:
Thanks for the information.
well, your information is consistent with cholinergic urticarial condition.
It is an hypersensitivity(allergic) state to an increased cholinergic State in the body.
Example. such as increased stress levels, sweating or exposure to hot temperature, spicy food, anxiety, etc.
There is tingling sensation with lesions on skin associated with intense bouts of itching. The condition is more severe during winters and more in person with dry skin issues.
The cause for such a condition is unknown it can happen to anyone and there is no specific etiology for it. Like any other allergic state.
The treatment is same as for any other common allergy, i.e.
1. Avoid the triggering factors. in your case avoid over clothing.
2. Avoid certain food stuffs that are high in serotonin content( the chemical that is responsible for production on acetylcholine). eg, capsicum, lady finger, brinjal, are you etc. For a detailed work up and information you can take help of dietician.
3. Avoid letting your skin remain dry. Application of moisturizer and skin lotion twice a day, one after bathing and one before sleep. Here you can avoid having bath with hot water, a XXXXXXX warm or cold water bathing is recommended.
4. For medication i would suggest an anti histaminic drug like Tab Hydroxyzine 25 mg one at bed time and tab certizine 5 mg one in the morning for 15 days. Being an idiopathic condition the condition should subside on its own within few weeks.
5. I would advice to keep the stress levels at minimum by avoiding over working, doing moderate exercise and adequate sleep. Avoid eating junk food.
6. For your muscle sore i suspect that it is due to the associated anxiety that is causing the problems. It should subside concurrently and no seperate intervention is needed as of now. In case it is severe and persist to continue then it is advisable to see a local physician.
For your other related concern since the investigations have come up to be normal there is no reason to be worried about other organic pathology. Your liver reports are normal and therefore nothing to worry at that.
For best results i still would recommend you to consult and discuss the above with your local dermatologist or visit a near allergy clinic.
Hope to have satisfied your query.
welcome for further suggestions.
Regards,
Dr Pankaj
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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