What's causing this intense mid-back itch?

A 63-year-old woman presents with a six-month history of episodic pruritus of her mid upper-back.

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Professor Murrell is head of dermatology at St George Hospital, Sydney, and conjoint professor at the University of NSW, Sydney.

This article was co-authored by Brendon Lee, a medical student at UNSW and Dr Melissa Radjenovic, a dermatology research fellow at St George