Question

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.

Answer 1

1, Three conditions to be considered are allergic rhinitis, atopic dermatitis(eczema) and asthma. Allergic rhinitis condition patient has a history of yardwork it may cause allergic rhinitis symptoms and there will be a chance for asthma because allergic rhinitis condition usually accompanies with eczema.
2, a, History:
Patient having risk factors of family history of a mother with asthma, eczema and patient medical history of allergic rhinitis that can accompany with patient atopic dermatitis condition.
b, Physical examination:
Patient itchy skin lesion and scally skin and erythematosus indicate the symptoms of atopic dermatitis.
c, Diagnostic studies:
Physical examination of skin and medical history provides relevant data for this condition. a patch test can identify the condition.
3, control the itching with corticosteroid creams and ointment. calcineurin inhibitors affect the immune system to control the skin reaction. oral corticosteroids help reduce the inflammation. injection monoclonal antibody used to treat general condition If any other treatment option not responded. Avoid exposure to strong sunlight to avoid the risk of skin cancer. Topical corticosteroids with wet dressings will be effective for treating widespread lesions.