Response to Lyndsay

Please write a response on my colleague Lyndsay’s post below egarding case study 1 (See attached picture of case study1). Thank you!

Case Study 1

A 46-year-old male presents to the office complaining of a pruritic skin rash that has been present for a few weeks. He initially noted the rash on his feet, but it then spread to between the fingers, his wrist, and waist. He notes that it does not seem to be on his face or trunk. He recently came home from a trip to Florida where he had stayed in multiple hotels. He takes occasional ibuprofen for knee pain, but denies taking other medications or having other health problems. He has no known drug allergies. The physical examination reveals a male with several tiny vesicles and scales in between the fingers, on the feet and ankles, around the patient’s wrist and around the belt line.

 

(Lyndsay’s Post)

Formulating differential diagnoses for many skin disorders requires knowledge of characteristics of skin issues (Buttaro, Trybulski, Polgar-Bailey, Sandberg-Cook, 2017). This patient is a 46-year-old male with a pruritic skin rash for several weeks. Travel history includes a trip to Florida while staying in multiple hotels. Past medical history includes occasional knee pain with ibuprofen as treatment PRN. The patient does not take other medications. Rash started on his feet and then appeared between fingers, wrist, and waistline. No rash noted to trunk or face. The examination also noted vesicles on his ankles. 

Skin infections have become the most prevalent reason for outpatient visits (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017). Based on patient history and presentation, the primary diagnosis will be cellulitis. The most common cause is S. aureus (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017), and given his travel history ruling out an infectious process is important for early treatment. 

Given the location of vesicles along the nerve tracts, a differential diagnosis of herpes zoster will be made. This is an infection from a varicella-zoster virus in a latent state and begins as pain along dermatomes with vesicular eruption within 2 to 3 days (Kaye, 2019). Clinical evaluation can include varicella history and a biopsy with antigen detection (Kaye, 2019). 

The second differential diagnosis includes contact dermatitis, which is a form of eczema. Contact dermatitis can be caused by friction on the skin, an allergen to skin, irritating chemical/soap, or rubbing too hard (National Eczema Association, 2020). A deeper history should be obtained regarding any change in household products or related to patient’s job, which could be the culprit. 

The third differential diagnosis will be bed bug bites, given the travel history with multiple hotel stays. Symptoms of bed bug rash include red and swollen skin in clusters that generally appear in a zig-zag pattern (American Academy of Dermatology, 2020). Further assessment of symptoms needs to be obtained, including any persons in the household with similiar symptoms. The biggest priority will be to treat symptoms with corticosteroids or antihistamines, even antibiotics if an infection is suspected (American Academy of Dermatology, 2020). Secondly, getting rid of bed bugs where the patient has been since exposure, is important to prevent further spread. 

 

 

Resources: Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice(5th ed.). St. Louis, MO: Elsevier.

 

·      Part 5, “Evaluation and Management of Skin Disorders” (pp. 237-325) 

This part explores the pathophysiology, clinical presentation, and management of various skin disorders, including dermatitis, dry skin, fungal infections, and herpes. It also examines the pathophysiology, clinical presentation, physical examination, diagnostics, and management of wound healing.