Question

1. A 27-year old woman complains of multiple small tender lumps in her right and left axillae. She explains that she has noticed that they seem to make "tunnels" and sometimes open and smell bad.

2. For the case you have chosen, post to the discussion:

3. Discuss what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed.
4. In SOAP format, list:
   • Pertinent positive and negative information
   • Differential and working diagnosis
   • Treatment plan, including: pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.

Answer 1

In the above case scenario,patient has hydradenitis suppurativa.This is a chronic condition affecting the skin especially the areas under axilla,breast, inguinal and genital areas.It is otherwise known as verneuil’s disease or acneinversa.

All the details will be added in SOAP format.

Subjective Data

1.patient complains of painful lumps which smells bad some times and forming tunnels.

Objective Data

Here the possible question might ask to the patient include,

1. Medical history
2. Medication history
3. Social history- smoking habit , because it is a predisposing factor.
4. Nutrition. Patient food habits is important factor to know because obesity is an another risk factor.
5. Age - usually occurs between 19-30 years.
6. laboratory results- not given here.

Assessment

From the patient subjective data +objective data + chief complaint it is diagnosed as hydradenitis suppurativa.

On physical examination, to check,

> site of lumps

>character- draining  or dry.

>size and distribution.

There is no specific diagnostic procedure available, but if the patient has pus , it should be send for testing to know about any bacterial growth.

Differential diagnosis

1.boil

2.pilonidal sinus

3.carbuncle,furuncle

1. Absess.

The working diagnosis might be boil, because as per different studies, hydradenitis suppurativa often misdiagnosed as boils and get worse later.

Treatment plans.

1 Pharmacotherapy.

• Treat with antibiotics. Topical or systemic antibiotics can be used according to patient conditions.
• Corticosteroids- for anti inflammatory effects help to stop the breakout.
• Hormones- as the disease common in puberty, hormones which helps to decrease the effects of hormones in males and females .
• Oral retinoids. This class of drugs works by decreasing inflammation and reducing the rate of skin cell turnover.

2 complimentary therapy.

• Application of warm compress or warm wash clothes over the area to relive pain and swelling.
• Use of tea-tree oil - it has anti bacterial properties.
• Use small amount of bleach in bathing water.

3 OTC in Hydradenitis suppurativa

• NSAID’s such as ibuprofen for pain and inflammation.
• Lidocaine can be use to make the numbness over the area.

4 Health education includes

• Explain the patient to keep the area clean and dry always. Advise to use an anti bacterial soap to clean the area.
• Advice to use loosely fitting and breathable dress to avoid friction.
• Educate the patient how to trim the hair and tell them to avoid shaving on the area.  

5  Lifestyle changes

• Manage body weight.
• Do regular exercises.
• Eat healthy food.
• Quit smoking.
• Stay stress free.

As discussed above , hydradenitis suppurativa is a chronic condition and there is chance of mis diagnosis, proper care should be taken. Explain the patient to manage the symptoms.