A Farmer With Pruritus and a Strange Suntan

Eric Fox, DO; Neal T. Patel; Anand D. Patel, MD


September 07, 2023

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 54-year-old man presents owing to diffuse pruritus that has lasted 1 week. He is a farmer and spends much of his day outdoors. He notes that his summer tan has not faded.

The patient has no significant past medical history. His father has type 2 diabetes mellitus, nonischemic cardiomyopathy, and cirrhosis, and his mother has congestive heart failure, coronary artery disease, and a history of tobacco use.

He has not had fever, nausea, or vomiting. He has not taken anything to treat the pruritus. He has never consumed alcohol or used tobacco products or illicit drugs. The patient fears that he will be unable to continue his work outside because of his skin changes.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.