Case Study – Differential Diagnosis of Skin Conditions

Case Study – Differential Diagnosis of Skin Conditions

Chief complain

Red patches on the skin which are itchy and burning with no control over scratching them all the time

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History of presenting illness

James is a 28-year-old male client who attended the healthcare facility. He has itchy red bumps on his skin that do not allow him to control his scratching. He explained that the rushes started three weeks ago, and he hoped they would go away, but they became bigger, and the skin started peeling off. He also states that the rashes are painful, and if he scratches for a long time, it become more painful, itchy, and sometimes bleeds. He also reports that his joints have also become stiff, and he cannot do things comfortably. On physical examination, the skin is dry and cracked, and there is the presence of silvery scales on the bumps. The client also has thickened nails on observation.

Differential diagnosis

Eczema causes itchiness and dryness of the skin and occurs mostly on the face, neck, hands, ankles, and even eyelid. It causes small raised bumps, which may leak fluid (Agha et al., 2016). It may also affect pigmentation and thus might make the affected part lighter and darker
Psoriasis presents with itchy skin and red bumps, which are painful. The skin becomes dried and cracked and might bleed at times when scratched. There are also signs of thick, pitted cracks on the nails (Limaye, 2015). These are the main presentations.
Pityriasis rubra pilaris causes pink, red scaly patches on the skin, which are usually itchy, and it might cause the development of patches on one side of the body and most often on elbows, knees, hands, and feet (Brown & Badri, 2019). The skin may be thickened, and the scaly patches may spread to the whole body.

Actual diagnosis

The correct diagnosis for the condition is psoriasis due to the fact that the client reported some form of bleeding from the cracked parts of the skin on scratching. Presence also of pitted nails suggests psoriasis. There is also the presence of stiff joints, which is not present in the above condition as they do not present with it.

References

Agha, H. M., Asim, S. A., Alam, M. Z., & Wahid, Z. (2016). ECZEMA. The Professional Medical Journal, 23(01), 060-064.

Brown, F., & Badri, T. (2019). Pityriasis rubra pilaris. In StatPearls [Internet]. StatPearls Publishing.

Limaye, K. (2015). Psoriasis: an overview and update. The Nurse Practitioner, 40(3), 23-26.

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Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.

Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?

Differential Diagnosis of Skin Conditions

Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.

Consider which of the conditions is most likely to be the correct diagnosis and why.

Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.

Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.

Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.

THE LAB ASSIGNMENT

Choose one skin condition graphic (identity by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.