The Differential Diagnosis For Skin Conditions essay

The Differential Diagnosis For Skin Conditions essay

History of Present Illness (HPI):

J.M is a 45 years old male who presented at the clinic with complaints of recurrent patchy erythema for over three months. Initially, it started with clear vesicles that cloud, rapture, and crust. The scars were treated at a local clinic with topical medication but persisted after treatment. The erythema involved one side of the back from the mid-region spreading to the left lateral side of the scapula. It was associated with pain, itchiness, and left cervical and axillary swelling of the lymph nodes. He denied fever and exposure to skin irritants. The Differential Diagnosis For Skin Conditions essay

Medications:

HAART (lamivudine, dolutegravir, and tenofovir) and septrin 960mg bid

Allergies: none

Past Medical History (PMH): the patient is HIV positive and on follow-up at his local comprehensive clinic.

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Past Surgical History (PSH): none

Sexual/Reproductive History: he is bisexual, rarely uses protection, and is a commercial sex worker.

Personal/Social History: J.M is a single African male working as a commercial sex worker at a local shopping center. He uses intravenous drugs, smokes cigarettes, and takes alcohol occasionally.

Health Maintenance: he regularly attends the comprehensive clinic for a check-up and refilling his medicine.

Immunization History: the immunization schedule is up to date. The last pneumococcal vaccine was six months ago.

Significant Family History: J.M is the firstborn in a family of five. His siblings and parents are alive and healthy. He denies a history of chronic illnesses in the family.

Review of Systems:

General: the patient is well-built, has a good memory, and denies a history of body weakness and weight loss.

HEENT: the client denies a history of headache, visual disturbances, hearing problems, and ear infections. The Differential Diagnosis For Skin Conditions essay

Respiratory: the patient denies a history of cough, running nose, chest pain, wheezing, and breathlessness.

Cardiovascular/Peripheral Vascular: the patient denies a history of syncope, orthopnea, and paroxysmal nocturnal dyspnea.

Gastrointestinal: the patient denies a history of abdominal pain, vomiting, nausea, and changes in bowel patterns.

Genitourinary: the client denies a history of hematuria, dysuria, and urine incontinence.

Musculoskeletal: the patient does not have arthritis, myalgia, and arthralgia.

Neurological: the patient has no history of paresthesia and gait disturbance.

Psychiatric: the patient is oriented to time, place, and person. He has no history of depression, mood swings, or bizarre behavior.

Skin/hair/nails: the left scapular region has an erythematous cutaneous surface extending to the lateral side. The left axillary lymph node is palpable.

OBJECTIVE DATA:

Physical Exam: the patient is well-kempt. He is not pale, has no jaundice, dehydration, and edema.

Vital signs: blood pressure 124/78mmHg, temperature 36.1, BMI at 28kg/m², and pulse at 80b/min.

General: the patient is oriented and has a good memory

HEENT: the head is a-traumatic, no facial droop, nasal and ear discharge, and the mucosa is pink and moist.

Neck: there is no elevated jugular

Chest/Lungs: the chest wall is symmetrical, with no mass, no crackles, and wheezing.

Heart/Peripheral Vascular: the pulse rate is present and regular, s1 and s2 are present, and no murmurs are present.

Abdomen: the abdomen is of normal contour, bowels sounds are present, no tenderness, and no organ enlargement.

Genital/Rectal: the patient denied examination

Musculoskeletal: the muscles are well-developed. There are no signs of muscle atrophy.

Neurological: all the cranial nerves are intact.

Skin: there is a raised erythematous and well-demarcated plaque on the left scapular. The erythema spreads to one dermatome. The Differential Diagnosis For Skin Conditions essay

Diagnostic results:

Lab tests and results

Tzanck smear shows multinucleated giant cells.

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ASSESSMENT:

Differential diagnosis

Herpes zoster

Herpes zoster is a viral infection that occurs with the reactivation of the varicella-zoster virus. It presents with a painful dermatomal rash. Herpes zoster occurs in three stages; the pre-eruptive phase, acute eruptive phase, and chronic phase (Kawai, K., & Yawn, B. P. (2017). The pre-eruptive phase presents with a sensory phenomenon that has pain, itchiness, and paresthesia. The acute eruptive phase presents with patchy erythema in the dermatomal area of involvement. The erythema abruptly stops at the midline. The chronic phase presents with pain and erythema that persists months after the onset. Herpes zoster is common in immunosuppressed patients. It is also a common illness in stage three HIV/AIDS.

Atopic dermatitis

Atopic dermatitis is a skin condition that presents with erythema, itchiness, and scaling. The skin lesions commonly affect the back, face, neck, and chest (Boothe, et al, 2017). The skin changes are a result of an object or organism in the skin.

Eczema

Eczema is an immune system disorder characterized by over-reaction to an allergy. It begins in childhood with less severe symptoms. According to Agner, T., & Elsner, P. (2020), it presents with patchy skin erythema that is itchy.

Specific diagnosis for this client

The specific diagnosis for this patient is herpes zoster. The patient presented with well-demarcated erythema located on one dermatome. It has persisted for over three months. The patient is immune-compromised and takes HAART. The Differential Diagnosis For Skin Conditions essay

References

Agner, T., & Elsner, P. (2020). Hand eczema: epidemiology, prognosis and prevention. Journal of the European Academy of Dermatology and Venereology, 34, 4-12.

Boothe, W. D., Tarbox, J. A., & Tarbox, M. B. (2017). Atopic dermatitis: pathophysiology. Management of Atopic Dermatitis, 21-37. The Differential Diagnosis For Skin Conditions essay

Kawai, K., & Yawn, B. P. (2017, December). Risk factors for herpes zoster: a systematic review and meta-analysis. In Mayo clinic proceedings (Vol. 92, No. 12, pp. 1806-1821). Elsevier.

Skin Comprehensive SOAP Note Template

 Patient Initials: _______                 Age: _______                                   Gender: _______

 SUBJECTIVE DATA:

 Chief Complaint (CC):

 History of Present Illness (HPI):

 Medications:

 Allergies:

 Past Medical History (PMH):

Past Surgical History (PSH):

Sexual/Reproductive History:

 Personal/Social History:

Health Maintenance:

 Immunization History:

Significant Family History:

 Review of Systems:

General:

            HEENT:

            Respiratory:

            Cardiovascular/Peripheral Vascular:

            Gastrointestinal:

            Genitourinary:

            Musculoskeletal:

            Neurological:

            Psychiatric:

            Skin/hair/nails:

 OBJECTIVE DATA:

Physical Exam:

Vital signs:

General:

HEENT:

Neck:

Chest/Lungs:.

Heart/Peripheral Vascular:

Abdomen:

Genital/Rectal:

Musculoskeletal:

Neurological:

Skin:

 Diagnostic results:

 ASSESSMENT:

 PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses. The Differential Diagnosis For Skin Conditions essay