31-Year-Old Female with Diffuse Itchy Skin and Nail Changes

A 31-year-old female presented with diffuse itching for about 6 months. She expressed frustration because she had seen three different doctors who told her that her itching is because of her anxiety. She reported heavy periods, which she had for years. She also mentioned frustration with her fingernails and stated they have become thin over time. She wondered if her nail changes were related to using acrylic nails. Her medications included sertraline for the past 6 years.