Differential Diagnosis for Skin Conditions Essay Discussion Paper
Patient Initials: AJ Age: 26yo Gender: Female
SUBJECTIVE DATA
Chief Complaint (CC): “I have a painful rash and joint pain on my left hand.”
History of Present Illness (HPI):
AJ is a 26-year-old Caucasian female who presents to the clinic today with joint pain and a painful plaque-like rash that started three weeks ago. She also reports that the rash is slightly itchy and sore, which started immediately after coming into contact with poison ivy. AJ also reports that she has been experiencing achy joints within the last three weeks, which makes the situation stressful. Within these three weeks, AJ reports that she had tried to change her laundry detergent with no rash improvement. Also, the patient reports that she has been under Ibuprofen 400mg, which she takes three times every day, which helps with pain relief. AJ also reports the joint pain and rash severity as 6/10. Differential Diagnosis for Skin Conditions Essay Discussion Paper
ORDER HERE A PLAGIARISM-FREE PAPER HERE
Current Medications
- Over-the-Counter Ibuprofen 400mg PO every five hours as needed.
- Atorvastatin 20mg oral, one tab, PO, Daily
- Ortho Tri-Cyclin 1 tablet PO daily
- Women’s Multivitamin 1 tablet PO daily
Allergies: No known environmental, food, or drug allergies.
Past Medical History
- Appendicitis
- Recurring tonsils
- Varicella
Past Surgical History
- Appendectomy 2010
- Tonsillectomy 2014
Sexual/Reproductive History
The patient is heterosexual, and AJ reports regular menses and menarche at age 12. The patient also reports that she is sexually active and is currently under an oral contraception regimen for the last two years. The patient denies risky sexual behavior engagement but reports she had her last pap smear in 2016, which projected normal results. Differential Diagnosis for Skin Conditions Essay Discussion Paper
Personal/Social History
The patient is unmarried but has been dating for the last two years, even though she currently lives with her parents. AJ denies illicit drug, tobacco, and other illegal substances use. AJ reports that she always maintains a healthy diet and exercises regularly. Consequently, AJ reports that she moderates her sun exposure and uses sunscreen when necessary.
Immunization History
The client reports that she has received all the required childhood immunizations. She also reports receiving the pneumococcal vaccine in 2016 and Tdap in 2017. Also, in 2018, the patient reported being immunized for influenza.
Significant Family History
- AJ’s Mother – Aged 45, was diagnosed with breast cancer in 2008 and is currently in remission.
- AJ’s Father – Aged 50, has multiple allergies and an eczema history.
- AJ’s Maternal Grandfather – Aged 71, has a history of allergic contact dermatitis, psoriatic arthritis, and psoriasis.
- AJ’s Paternal grandmother- Aged 76 and with allergic contact dermatitis and eczema history.
- AJ’s two siblings, a female, 15 years, and a male, 18 years, have a history of a recent fungal- infection-type unknown.
Lifestyle
AJ started her cosmetology career after graduating from the local community college. Considering that she has been living with her parents, she is planning to look for her own apartment before moving in with her boyfriend if things work well for them. She wants to move out mainly because the house is cramped, considering that she usually sleeps on the sofa. AJ’s exercise and diet regimens are healthy. She reports that her support system is strained since the mother has to take care of the school fees of her younger brother, who is joining college. Also, she reports that she is yet to make friends with her new workmates. Differential Diagnosis for Skin Conditions Essay Discussion Paper
Review of Systems
General: AJ denies night sweats, chills, fever, fatigue, or significant weight changes.
HEENT: Denies hearing or vision changes. AJ denies double or blurred vision, ear discharge, or tinnitus. AJ also reports that she had her last visual exam in 2016, but she denies postnasal drip, nosebleeds, and vertigo. She denies bleeding gums, tooth, and throat issues. However, she reports that her last dental evaluation was three months ago.
Neck: Denies any form of pain in her neck.
Breast: Denies discharge from her nipple.
Respiratory: AJ denies any respiratory complications.
Cardiovascular/Peripheral Vascular: Denies palpitations
Gastrointestinal: Denies constipation and diarrhea.
Genitourinary: Denies urinary, bowel, and genital-related complications.
Musculoskeletal: She reports joint pain. Denies fractures, trauma, arthritis, and gout history.
Psychiatric: AJ reports sleep disturbances due to the itchy skin rash and joint pain. She also reports increased stress and socialization issues. However, she denies a depression and anxiety history, including any suicidal thoughts.
Neurological: No report on known neurological-related complications.
Skin: AJ reports an itchy and red rash on her left hand. The patient, however, does not have any pigment changes. Differential Diagnosis for Skin Conditions Essay Discussion Paper
Allergic/Immunologic: No known environmental, food, or drug allergies. Also, no reports on immunologic disorders.
OBJECTIVE DATA
Physical Exam:
Vital signs: T- 97.8; B/P: 112/68 right arm; P- 82; Wt.: 130 lbs.; Ht: 5’7”; BMI: 20; RR- 17
General: AJ, a 26-yo Caucasian who is well-groomed and nourished, AAOx3, appears uncomfortable, has a normal gait, and has no apparent distress. Also, she is very attentive during the assessment period.
HEENT: EOMI, no redness or swelling of the nasopharynx, PERRLA
Neck: Supple and non-tender neck.
Chest /Lungs: Non-labored respirations.
Heart/Peripheral Vascular: regular rhythm with no murmur and normal rate.
Abdomen: Soft and non-tender.
Musculoskeletal: mild wrist swelling, symmetric muscle development, ankle, and knee joints bilaterally, and pain is present. Differential Diagnosis for Skin Conditions Essay Discussion Paper
Skin: Salmon-colored in several areas, polycyclic plaques on knees and elbows, which are approximately 1 cm and have discrete borders. Slightly painful to palpation and sore. No other rashes and thick acrylic nails, which limit nail assessment.
Lab Tests and Results
CBC- WBC 8,000
Assessment
Allergic Contact Dermatitis – Primary diagnosis
Allergic contact dermatitis is AJ’s primary diagnosis and is mainly linked to itchy and red skin, as presented by AJ (Silverberg et al., 2020). Other symptoms include dry skin, burning feelings, and sun sensitivity. However, individuals develop the symptoms once they come into contact with allergens like poison ivy, poison sumac, and poison oak (Silverberg et al., 2020). From the patient’s history, the patient reports a red and itching rash on the left hand, which began after contact with poison ivy. Differential Diagnosis for Skin Conditions Essay Discussion Paper
Dermal reactions
Dermal reactions can also be diagnosed for AJ. According to Thá et al. (2021), this skin condition is characterized by a rash, redness, itching, cracked skin, swelling, raised bumps, and peeling and scaling of the skin. Due to the client’s description of a red rash on her left hand, this diagnosis is appropriate for her. However, dermal reactions were ruled out since other important signs, such as swelling and raised pimples, were absent.
Erythema multiforme
AJ may also be diagnosed with erythema multiforme. The symptoms of this ailment range from itching, weariness, cold sores, joint pains, and fever to red patches and blisters that appear unexpectedly. The patient meets the criteria for this diagnosis since her left hand is itchy, blistering, and covered in a red rash (Soares & Sokumbi, 2021). However, this condition is ruled out due to the lack of some important symptoms, including cold sores, fever, and exhaustion.
Cutaneous lymphoma
The disease is yet another differential diagnosis for AJ. That is because round, itchy, and elevated patches, the formation of lumps on the skin, hair loss, enlarged lymph nodes, and thickening of the skin on the palms and soles of the feet are its distinguishing features (Jonak et al., 2019). The patient meets the criteria for this diagnosis since her left hand is itchy, blistering, and covered in a red rash. However, the lack of some important symptoms, such as skin lumps, hair loss, enlargement of the lymph nodes, and thickening of the skin on the palms, rules out this condition. Differential Diagnosis for Skin Conditions Essay Discussion Paper
ORDER TODAY
Granulomatous and pustular reactions
The final differential diagnosis for AJ is this condition. It is distinguished by pimples that develop into a rash on different body areas, such as the arms, trunk, and legs. There is itching and discomfort from the rash (Tajima et al., 2022). The patient meets the criteria for this diagnosis since her left hand is itchy, blistering, and covered in a red rash. However, this condition is disregarded since there are no pimples, which often form rash on the arms, torso, and legs.
References
Jonak, C., Porkert, S., Oerlemans, S., Papadavid, E., Molloy, K., Lehner-Baumgartner, E., Cozzio, A., Efficace, F., & Scarisbrick, J. (2019). Health-related Quality of Life in Cutaneous Lymphomas: Past, Present and Future. Acta Dermato Venereologica, 99(7), 640–646. https://doi.org/10.2340/00015555-3171
Silverberg, N. B., Pelletier, J. L., Jacob, S. E., & Schneider, L. C. (2020). Nickel Allergic Contact Dermatitis: Identification, Treatment, and Prevention. Pediatrics, 145(5), e20200628. https://doi.org/10.1542/peds.2020-0628
Soares, A., & Sokumbi, O. (2021). Recent Updates in the Treatment of Erythema Multiforme. Medicina, 57(9), 921. https://doi.org/10.3390/medicina57090921
Tajima, A., Yamazaki, F., Huynh, T. N. M., Ueda‐Hayakawa, I., Kishimoto, I., Itsukage, S., Kume, N., & Tanizaki, H. (2022). A case of palisaded neutrophilic and granulomatous dermatitis associated with systemic lupus erythematosus presenting with pustules. The Journal of Dermatology, 50(2), 262–265. https://doi.org/10.1111/1346-8138.16605
Thá, E. L., Canavez, A. D. P. M., Schuck, D. C., Gagosian, V. S. C., Lorencini, M., & Leme, D. M. (2021). Beyond dermal exposure: The respiratory tract as a target organ in hazard assessments of cosmetic ingredients. Regulatory Toxicology and Pharmacology, 124, 104976. https://doi.org/10.1016/j.yrtph.2021.104976 Differential Diagnosis for Skin Conditions Essay Discussion Paper