Unexplained Skin Dysesthesia with Systemic Symptoms

Case at a Glance

A 28-year-old female presented with a constellation of symptoms including significant hair loss, weight loss, leg pain, and unusual skin sensitivity affecting bilateral forearms.

Patient's Story

The patient reported experiencing approximately 50% hair loss over recent months, accompanied by unintentional weight loss and bilateral leg aching. She described developing an unusual skin sensation on her right forearm between the wrist and elbow, characterized by extreme tactile hypersensitivity. The patient described the sensation as uncomfortable when touched, comparing it to 'going against the grain' or producing a 'nails on chalkboard' feeling. This abnormal skin sensitivity subsequently appeared in the corresponding area of her left forearm. The patient emphasized that while not painful, any contact with these areas produced an intensely unpleasant, shiver-inducing sensation.

Initial Assessment

Physical examination revealed bilateral areas of tactile dysesthesia on the forearms. The patient appeared to have noticeable hair thinning consistent with her reported hair loss. Current medications included sertraline for mood disorders, amphetamine salts for attention deficit disorder, and oral contraceptives.

The Diagnostic Journey

Given the constellation of hair loss, weight loss, bilateral leg pain, and neurological symptoms including skin dysesthesia, a comprehensive workup was initiated to investigate potential autoimmune, endocrine, or neurological etiologies.

Final Diagnosis

Skin dysesthesia of unknown etiology with associated systemic symptoms requiring further investigation

Treatment Plan

Symptomatic management of dysesthesia while pursuing comprehensive diagnostic workup including autoimmune markers, thyroid function, vitamin levels, and neurological evaluation

Outcome and Follow-up

Patient scheduled for follow-up appointment to discuss diagnostic results and symptom progression. Initial consultation confirmed the presence of tactile dysesthesia, with medical literature supporting hundreds of potential underlying causes requiring systematic evaluation.