Chief Complaint A 24 y.o. male presents for a pre-employment physical and mentions a rash on his chest. He noticed the rash last night and says it is “very itchy.” He has not noticed any other skin changes. Overall, he feels well without any accompanying symptoms. He is a teacher and spent most of last weekend doing yard work.
Past Medical History
• Allergic rhinitis, uses over-the-counter antihistamines
• Denies surgeries or serious illnesses/hospitalizations
Family History
• Father, hypertension
• Mother, asthma, atopic dermatitis
• Brother, atopic dermatitis
• Sister, diabetes
Physical Examination
• Vital signs; T 98.2, BP 126/78, RR 20, HT 80.
• General: Well developed and well appearing.
• Skin: Lesion on upper right anterior chest, midline below the clavicle. Measures approximately 3 cm by 2.5 cm, has mildly erythematous maculopapular margin, and is clearer centrally, with fine scaling.
Questions
1. What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)?
2. What further history, further examination, and diagnostic studies are warranted to explore your differential diagnosis?
A. History
B. Physical examination
C. Diagnostic studies.
3. Describe the management strategies for your primary diagnosis.
1.)
(i)Erythema annulare centrifugum (EAC) characterized by a scaling or nonscaling, nonpruritic, annular or arcuate, erythematous eruption. It tends to spread peripherally while clearing centrally.
Rationale : he takes over the counter anti-histamines. Hypersensitivity reaction to a variety of agents including drugs, insect bites, infections, food ingestion (blue cheese), malignancies causes EAC
(ii)Tinea corporis refers to a dermatophytosis or superficial fungal infection of the skin, other than on the hands, feet, scalp, face or groin.2 This condition is also commonly referred to as ringworm
Rationale : History of yard work present with the patient. Humans become infected with tinea corporis through close contact with infected persons, animals or soil.
(iii)Chronic plaque psoriasis (psoriasis vulgaris) plaque, sometimes extends peripherally, the central part undergoes clearing, causing the formation of annular lesions called annular psoriasis.
2.) History :
Any history of rashes present in other sites of body
Any discharge or pain from the rashes
If it leaves scars. Is it itchy
Any travel to other country
History of work with soil or plants
History of any previous allergies
Physical examination :
Type of rash
Any discharge
If rash present in other parts of body
Colour, texture, scales type and central clearing
Diagnostic tests
Skin biopsy
Scale examination
Complete blood count
Serological tests
Hypersensitivity tests
Culture if any infection
3.) Management :
Stopping anti- histamines to control hypersensitivity to drugs causing EAC
Anti fungals given for tinea corporis
Anti psoriatic drugs can be given for psoriasis
Chief Complaint A 24 y.o. male presents for a pre-employment physical and mentions a rash on...
Chief Complaint: Rash History of Present Illness A 24 y.o. male presents for a pre-employment physical and mentions a rash on his chest. He noticed the rash last night and says it is “very itchy.” He has not noticed any other skin changes. Overall, he feels well without any accompanying symptoms. He is a teacher and spent most of last weekend doing yard work. Past Medical History Allergic rhinitis Denies surgeries or serious illnesses/hospitalizations Current Meds Allegra OTC Family History...
Week 4 Case Study 66 unread replies.66 replies. Chief Complaint: Rash History of Present Illness A 24 y.o. male presents for a pre-employment physical and mentions a rash on his chest. He noticed the rash last night and says it is “very itchy.” He has not noticed any other skin changes. Overall, he feels well without any accompanying symptoms. He is a teacher and spent most of last weekend doing yard work. Past Medical History Allergic rhinitis Denies surgeries or...
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