Week 2 iHuman Child Assignment
The patient is a healthy 12-month-old female presenting for her routine well-child visit. During the visit, her mother noticed intermittent red, itchy patches on the child’s elbow creases and behind her knees over the last three weeks. Many of these patches appeared to be unrelated to any specific event: Week 2 iHuman Child Assignment.
In the development checklist analysis, it was identified that she is right on the age and developmentally appropriate for her age, as well as other aspects regarding her height and weight, where she is in the 50th percentile range. Skin examination revealed components of dermatitis, specifically red and scaly skin in the flexural areas in the elbow creases and behind the knees, with no evidence of infection or systemic disease.
Differential Diagnoses and Final Diagnoses
Differential Diagnoses
Eczema (Atopic Dermatitis)
The red, itchy, and scaly patches in flexural areas strongly suggest eczema. This skin disease affects most children before they turn two years of age and is characterized by chronic skin inflammation. Its periodic distribution and localization in areas that can easily be irritated or cause excessive sweating also point toward such a diagnosis (Nemeth & Evans, 2022).
Irritant Contact Dermatitis
This condition could result from exposure to irritants like harsh soaps, laundry detergents, or synthetic fabrics. However, the absence of a history of new products or clear exposure makes this less likely (Patel & Nixon, 2022).
Well-Child Status
This differential involves a general assessment of the child’s medical history and physical and psychomotor development, which are within the standard, excluding skin abnormalities.
Final Diagnoses
Eczema (Atopic Dermatitis)
Management Plan
Pharmacological Treatment
First-line pharmacological treatment includes a low-potency topical corticosteroid (Lax et al., 2022), such as 1% hydrocortisone cream, applied twice daily to affected areas for seven days. This is supported by frequent emollients like fragrance-free moisturizers (e.g., CeraVe or Eucerin) to repair the skin barrier and reduce flare-ups. These treatments are essential in managing the inflammation and dryness characteristic of eczema.
Non-Pharmacological Measures
Non-pharmacological measures include avoiding triggers such as harsh soaps, synthetic fabrics, and exposure to allergens. Additionally, caregivers should use lukewarm water for bathing and immediately apply moisturizer to lock in moisture and protect the skin.
Addressing Social Determinants of Health (SDOH)
Family involvement in the management plan was evaluated in terms of funds to procure the conveyed medication and over-the-counter emollients. The mother reported that there were no hindrances to getting these products or coming back for a follow-up. They also offered the family a clinic should they require further assistance from other supportive agencies.
Patient Education
Patient education focused on empowering the family to manage eczema effectively. The family was informed that eczema is a chronic condition that requires consistent care to prevent flare-ups, the necessity of daily emollient use, the use of hydrocortisone ointment in case of the onset of acute manifestations, as well as the detection of the presence of secondary infection, either localized, in the form of nodules or generalized, with redness and swelling or purulent discharge (Wilken et al., 2023). Further, reference printed materials concerning eczema and skincare practices were available, and the mother showed an understanding of how to practice the formulated care plan.
Follow-Up Instructions
Follow-up instructions were clearly communicated to ensure continuity of care and optimal outcomes. The family was advised to return for the child’s next well-child visit at 15 months of age. They were also advised to consult a doctor if the eczema symptoms do not change or get worse within 2 weeks of beginning a new treatment plan or if there are elements of infection (Patel & Nixon, 2022). The general advice given to parents during the interim period was the frequent observation of the child’s growth and development, with the added reassurance that any problems could be solved during subsequent check-ups.
Conclusion
This case demonstrates the importance of a comprehensive approach to diagnosing and managing eczema in children. The primary objective of the management plan is to combine pharmacotherapy, non-drug interventions, assessment and modification of clients’ social needs, and patient counseling. The plan aims to minimize the clients’ symptoms and enhance their quality of life. This approach allows comprehensive coverage of the child in the present and future.
References
Lax, S. J., Harvey, J., Axon, E., Howells, L., Santer, M., Ridd, M. J., Lawton, S., Langan, S., Roberts, A., Ahmed, A., Muller, I., Ming, L. C., Panda, S., Chernyshov, P., Carter, B., Williams, H. C., Thomas, K. S., & Chalmers, J. R. (2022). Strategies for using topical corticosteroids in children and adults with eczema. Cochrane Database of Systematic Reviews, 2022(3). https://doi.org/10.1002/14651858.cd013356.pub2
Nemeth, V., & Evans, J. (2022, August 8). Eczema. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538209/
Patel, K., & Nixon, R. (2022). Irritant Contact Dermatitis — a Review. Current Dermatology Reports, 11(2). https://doi.org/10.1007/s13671-021-00351-4
Wilken, B., Zaman, M., & Asai, Y. (2023). Patient education in atopic dermatitis: a scoping review. Allergy, Asthma & Clinical Immunology, 19(1). https://doi.org/10.1186/s13223-023-00844-w
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Question 
The patient is a healthy 12 month old female who is here for her well visit. Her mother states she had noticed some patches of red, itchy skin on her elbow creases and behind her knees that appears to come and go over the last three weeks. Developmental assessment is normal.
She continues to track along the 50% for both height and weight. Physical exam is only positive for red patches of skin on elbow creases and behind her knees today.
Different Diagnosis
- Eczema
- Irritant contact dermatitis
- Well-Child status
Final Diagnosis: Eczema
Differentials, and Coding: What were the key clinical presentations in this patient that led you to choose these differentials; then how did you rule them out to reach your primary diagnosis?
- Eczema
- Irritant contact dermatitis
- Well-Child status
Medications: Ordered (including over the counter) are appropriate, evidenced based, written as a complete prescription, and includes appropriate patient education.10 points
Week 2 iHuman Child Assignment
Management Plan: Nonpharmacological treatment, Social Determinants of Health (SDOH) is addressed and evidenced based screening tool is used. Clearly written plan covering all critical components for patient’s final diagnosis. SDOH and Health promotion/anticipatory guidance is addressed.20 points
Patient Education: Comprehensive patient education is included related to current health visit and recommended health screenings. 10 points
Follow Up Instructions are complete and include time to next visit and specific symptoms to prompt a return visit sooner. 10 points
Scholarly References and Clinical Practice Guidelines: The assignment includes a minimum of 3 scholarly references that are not older than 5 years. Clinical practice guidelines are included if applicable. 5 points