Differential Diagnosis for Skin Conditions
Subjective Data for Differential Diagnosis of Skin Conditions
Mr. J, 43, came to our hospital and explained that he had itching rashes on the lower part of his leg and suspected that he had a skin condition. Mr. J began experiencing this type of abnormality about two weeks ago and had come to our clinic for medical attention for his troubling condition.
Mr. J had come to seek medical attention for itching skin that had developed severe rashes.
Current Illness History (HPI)
Mr. J, a 43-year-old American citizen, exhibits the following skin manifestations: itchy, red, and swollen skin, dry and flaky skin, and scaly skin on his lower legs. Furthermore, the patient complains of leg swelling, particularly after prolonged standing and at the end of the day. His skin has brown discoloration as well as red, tender, and tight skin that has hardened over time. The skin condition is thought to be varicose eczema, also known as stasis eczema, a long-term skin condition affecting the lower legs. Varicose eczema is common in people who have varicose veins, a circulatory disease affecting blood vessels in the lower legs. Although varicose eczema is a chronic skin condition, treatments are available to keep it under control. However, the patient had no stiffness or other type of skin infection. The patient has been taking proper medications to control his skin condition, which includes the application of emollients to prevent dry skin, the use of topical corticosteroids to help treat eczema and relieve symptoms, and the daily use of compression stockings to help squeeze his legs tightly at the foot and ankle and become looser further up the leg, helping to improve blood circulation. The severe itching returned after the medication wore off, according to the patient. He gave his discomfort condition a 6 out of 10.
Physical Examination Based on Objective Data
B/P 110/72, weight 117Ibs, BIM 22, P 70 and regular, T 97.1 orally
Leg ulcers- Examination of damaged skin areas that took several weeks to heal.
Cellulitis is an examination of an infection in the deeper layers of the skin and underlying tissue.
Deep vein thrombosis is the Examination of a blood clot in one of the legs’ deep veins. Varicose veins are characterized by swollen and enlarged veins.
Assessment
10,000 CBC – WBC + left shift
SAO2- 96%
Ankle Brachial Pressure Index is a diagnostic tool (ABPI)
ABPI- performed to determine whether or not compression stockings are appropriate for the patient. Blood pressure readings from the ankles and upper arms were compared in the ABPI test. A significant difference in readings indicates a problem with blood flow through the arteries. Compression stockings may not be appropriate in this situation.
Diagnosis Differential (DDx):
Eczema with varicose veins
Ulcers on the legs
Deep vein thrombosis (DVT)
Cellulitis
Diagnosis/Patient Issues
Eczema with Varicose Veins
Thrombosis of the Deep Veins
Veins that are varicose
Treatment Strategy
Treatment should include a combination of the following:
Self-help measures include methods of improving blood circulation, such as exercising, staying active, and raising the legs frequently. Encourage regular attendance.
Emollients are moisturizers that are applied to the skin to keep it from drying out.
Topical corticosteroids are creams and ointments that are applied to the skin to treat and relieve varicose eczema.
Compression stockings are used to improve blood circulation.
If this treatment does not work, the patient should see a dermatologist to rule out other possible causes of the skin symptom.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s Guide to Physical Examination (8th Ed.). St. Louis, MO: Elsevier Mosby.
Barron, G., Jacob, S., & Kirsner, S., (2013) Dermatologic Complications of Chronic Venous Disease: Medical Management and Beyond. Ann Vasc Surg. 21(5):652-62.
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Question 
Assignment 1: Differential Diagnosis for Skin Conditions
Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms and incrementally narrow them down until one diagnosis is determined as the most likely cause.
Differential Diagnosis for Skin Conditions
In this Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.
To prepare:
· Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Assignment.
· Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
· 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.
· Download the SOAP Template found in this week’s Learning Resources.
To complete:
· 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 three to 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 3 different references from current evidence-based literature.