iHuman Kaylee Hales
Dermatology Case Study
Primary Care 1 (regis college)
lOM oAR c P S D | 2444 858 7
Kaylee Hales, 25 years old otherwise healthy
... [Show More] female, presented with two days of intensely
pruritic erythematous popular rash on the inner thighs and left inner forearm. Physical
examination shows a 6 cm set of linear circumscribes, erythematous blisters on the left inner
forearm, and a 10x12 cm scattered contiguous erythematous popular rash with surrounding
superficial excoriation on the inner thighs. Vitals and the remaining physical examination are
unremarkable. Recent exposures include hiking through the woods, hot tub use, new lotion use,
and ingesting scallops for the first time in her life.
PMH: no past medical history
Vital signs: 116/62, 70, 98.3, 95% room air, 20.
Four different diagnoses:
Contact Dermatitis (CD)
Contact dermatitis is a skin inflammation caused by direct contact with an allergen or
irritant. CD categorize into two subcategories allergy and irritant dermatitis. CD shares the same
cardinal symptoms as pruritic, erythematous rash, vesicular and linear, rough, redden patches,
weepy lesions with numerous tiny vesicles on an erythematous base that is pruritic or a burning
or sting sensation (Dunphy et al., 2019). Based on the patient's activity history, the patient went
hiking a couple of days ago; she wore shorts and tank tops and had possible exposure to toxic
plants on her extremities and upper arms. Poison ivy (Toxicodendron) dermatitis (TD) results
from contact with poison ivy, oak, or sumac. It is a common form of allergic contact dermatitis
(ACD) that affects millions of people in the United States annually (Kim, & slowly, 2019).
Toxicodendron dermatitis can cause discomfort, marked itching, and blisters formation (Butt et
al., 2019). The patient's rash appears pruritic, blister, and erythematous popular rash on her
thighs and inner arms. Based on these symptoms, contact dermatitis is the primary diagnose.
Pruritus
Pruritus is the sensation of itch accompanied by the urge to scratch (Dunphy et al., 2019).
Pruritus presents with rash or no rash. No rash pruritus is caused by internal diseases such as
renal, liver, the delusion of parasitosis, hyperparathyroidism, Hodgkin's lymphoma, and
polycythemia vera. Pruritus with a rash caused by external skin disease, insect bites, fungal
infestation, topical products, scabies, dry skin, or drug reaction. Besides pruritis, the patient has
other symptoms, such as vesicles on an erythematous base and a rash spreading from her thighs
lOM oAR c P S D | 2444 858 7
2
to her left arm, and she could identify the triggers. Therefore, a pruritus diagnosis is not the
appropriate diagnosis for this patient.
Urticaria
Urticaria is a sudden generalized eruption of pale, evanescent wheals or papules
associated with severe itching. Dunphy et al., 2019). Urticaria causes are drugs, foods, food
preservatives, insect bites, and bacterial, fungal, viral, or parasitic infections. Its cardinal
symptoms are hives or wheals that appear at a particular time of the day, resolve, and reappear
the next day. The etiology of urticaria has not been fully understood yet, but different triggers,
such as type I allergies, pseudo allergies, autoimmunity, drugs, and infections, have been
identified as causal factors (Antia et al., 2018). The patient may experience urticaria due to a
possible scallop allergy. However, the patient has vesicles on the erythematous base versus
wheals and papules, and the rash appeared two days ago. Based on these symptoms, urticaria
diagnose is ruled out.
Folliculitis.
Folliculitis is an infection of hair follicles that appears with yellow-white pustules and
papules on the erythematous base (Dunphy et al., 2019). The patient diagnosed with folliculitis
presents with non-pruritis pustules on the erythema base of the hair rash throughout the
body. Folliculitis (inflammation around the hair follicles) presents as a red papule (which may be
tender), with or without a pustule, and it can have a variety of causes (Osborne et al., 2020). In
this case, the patient may experience hot tub folliculitis. However, with hot tun folliculitis, the
rash must appear on all the body surfaces immersed in the hot tub, not only on the upper thighs
and left upper arms. Therefore, folliculitis is not the appropriate diagnosis.
Final diagnosis: Contact Dermatitis
Pharmacology
• Apply Clobetasol propionate 0.05% cream to the affected area twice a day for two
weeks.
• Cetirizine 10 mg tab, one tab daily as needed for itching. Non-pharmacology
• Take oatmeal baths
• Apply cool, wet compresses to affected areas
• Apply topical calamine lotion or aluminum acetate to the affected area
• Apply aloe vera gel to the area [Show Less]