“I itch all over but there’s no rash — just give me a cream”

Generalised pruritus WITHOUT a primary rash (only excoriations) is a flag to look for a SYSTEMIC cause, not just to treat the skin. The differential includes iron deficiency, thyroid and chronic kidney/liver disease (cholestasis), drugs, polycythaemia (classically itch after a hot bath — aquagenic pruritus), and — importantly — HAEMATOLOGICAL MALIGNANCY, especially lymphoma. The examinable core is directed questioning that uncovers the B-symptoms (drenching night sweats, unintentional weight loss, fatigue) the patient minimised, which with generalised itch strongly raise lymphoma and mandate EXAMINATION (lymph nodes, hepatosplenomegaly) and an urgent structured work-up (FBC + film, ferritin, U&E, LFTs, TFTs, ESR/LDH, calcium, imaging) with urgent/suspected-cancer referral where the threshold is met — not a cream. The hidden agenda is a noticed lump and an unvoiced cancer fear driving the "just give me a cream" minimisation; surface and address it, examine and act on the red flags, balance honest reassurance with taking them seriously, and give symptomatic itch relief ALONGSIDE — not instead of — the cause work-up.