Differential Diagnosis for Skin Conditions

1 Differential Diagnosis for Skin Conditions Patient Initials: ZE

Age: 49

Gender: M

SUBJECTIVE DATA: Chief Complaint (CC): 5 History of Present Illness (HPI): ZE presents with complains of itchy red patches that have formed on his elbow. The red patch is covered with silvery scales on some parts. He also complains of pain and stiffness on the joint. He reports that the skin condition had once occurred but was mild and cleared out on its own.

Medications: Over the counter painkillers for pain.

Allergies: None Past medical history: None.

Past surgical history: None.

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6512 WEEK 4 ASSIGNMENT 1: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS 2

Personal/ social history: The patient is a married man and lives with his wife and two children. He runs a family business for a living.

Sexual/reproductive history: Heterosexual. He has only one sexual partner.

Immunization history: He is up to date with his vaccines. He has recently received the influenza vaccine.

Significant family history: Both of his parents have high blood pressure and high cholesterol levels.

Review of Systems: General: + fever, no chills or night sweats; no recent weight gains of losses of significance HEENT: Reports occasional mild headache and fever. Denies changes in hearing or vision. He uses glasses.

Neck: No pain or injury.

Respiratory: No coughs, difficulty in breathing or shortness of breath.

CV: Within normal limits. No chest pains, murmurs or palpitations.

GI: Within normal limits. No abdominal pain, nausea or vomiting.

GU: No dysuria or increased frequency.

MS: ++joint pain, stiffness and swelling on the elbow. Itchy red patches with silver-like scales.

6512 WEEK 4 ASSIGNMENT 1: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS 3 Psych: No history of anxiety, depression, disturbance or mental health history. Denies any feeling of dizziness.

Neuro: Intact Integument/Heme/Lymph: Intact.

Endocrine: Intact.

Allergic/Immunologic: None.

OBJECTIVE DATA Physical Exam: Vital signs: B/P 132/88, oxygen saturation 94, HR 110, PR 69 and regular; RR: 18 non-labored; temperature 38.9; height 5’’6, weight 110 lbs.

General: AA&O x4.

Neck: Within normal limits.

Chest/Lungs: Symmetric chest wall. Respirations regular and easy; lungs sounds present and clear to auscultation in all fields bilaterally. No anterior or posterior crackles/wheezes.

Heart/Peripheral Vascular: Regular heart rhythm. No arrhythmia. Fast heart rate. No murmurs.

ABD: Normal bowel sounds. Non-distended. No hepatomegaly.

Musculoskeletal: Joint pain and stiffness.

Rectal: deferred.

Neuro: CN intact Skin/Lymph Nodes: Skin lesion on one elbow. Palpable lymph nodes.

ASSESSMENT: Lab Tests and Results: Complete blood count.

6512 WEEK 4 ASSIGNMENT 1: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS 4 Rheumatoid factor.

C- reactive protein.

Diagnostics: X-ray Differential Diagnosis: Psoriatic arthritis – This is an autoimmune disease that affects the skin causing lesions. The body’s immune system mistakenly attacks healthy cells causing inflammation that leads to joint pain, stiffness, and swelling (Habif, 2015). In most cases, skin symptoms, which occur as red itchy patches with silver-like scales appear before joint symptoms. Having psoriasis or a family history of psoriasis is a major risk factor for developing psoriatic arthritis.

Lichenification – also known as neurodermatitis is a condition characterised by an itchy patch of skin that undergo thickening and become leathery due to continuous scratching (Habif, Chapman, Dinulos, & Zug 2017). The patch becomes raised, rough, darker or red than the rest of the skin. Chronic irritation is often associated with conditions such as eczema.

Seborrheic dermatitis – This is a common type of skin infection that mainly affects the scalp but can also affect other parts of the body. It causes red, itchy and scaly patches with dandruffs. The cause is often associated with a fungal infection or irregular immune response.

Bowen’s disease – This is a form of skin cancer that affects the squamous cells. It presents as a skin patch with clear edges and does not heal. It is often red, scaly and either flat or raised (Habif et al., 2017). Unlike psoriasis, it is not necessarily itchy.

Correct diagnosis:

6512 WEEK 4 ASSIGNMENT 1: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS 5 The most probable diagnosis, in this case, is psoriatic arthritis. Similar to its presentation in the graphic, the skin condition is characterized by erythematous and infiltrated patches covered by white or silvery flaky scales (Calzavara-Pinton, 2013). It clearly shows the three morphological characteristics of psoriasis which are erythema, desquamation, and infiltration (Young, Aldredge, & Parker, 2017). Also, the condition is chronic and may go through periods of remission. The types of psoriatic arthritis vary depending on the affected parts of the body and the pattern of infection. This includes distal, which affects the fingers and toes, symmetric which affects joints on both sides of the body concurrently, asymmetric affecting one side of the body, spondylitis affecting the spine and neck and arthritis mutilans affecting small joints on fingers and toes (Lyons & Ousley, 2014).

6512 WEEK 4 ASSIGNMENT 1: DIFFERENTIAL DIAGNOSIS FOR SKIN CONDITIONS 6 References Calzavara-Pinton, P. (2013). Psoriasis differential diagnosis. Clinical Dermatology, 2(2), 60-66.

Habif, T. P. (2015). Clinical dermatology e-book. Amsterdam: Elsevier Health Sciences.

Habif, T. P., Chapman, M. S., Dinulos, J. G., & Zug, K. A. (2017). Skin disease e-book: Diagnosis and treatment. Amsterdam: Elsevier Health Sciences.

Lyons, F., & Ousley, L. E. (2014). Dermatology for the advanced practice nurse. New York, NY: Springer Publishing Company.

Young, M., Aldredge, L., & Parker, P. (2017). Psoriasis for the primary care practitioner.

Journal of the American Association of Nurse Practitioners, 29(3), 157-178.