Case Summary
RB, a 27-year-old woman, visits the clinic with an itchy vesiculopapular rash on her right forearm that began over the weekend. The rash is moderately red, linear, and shows signs of scratching, but no burrows are present. She denies new products, allergies, or family history of similar conditions. No one else in the household is affected. She reports recent yard work involving pulling weeds. Vitals are normal: BP 123/74, pulse 68, respirations 20, and temperature 97.9°F.
Additional Assessment Information
To diagnose the patient’s (RB) condition, it is crucial to learn more about her medical history, recent travel or exposure to unfamiliar settings, and any present-day changes in her activities or lifestyle. RB’s past experiences with insect bites or interaction with poison ivy-causing plants should also be thoroughly discussed (Dinulos, 2019). Reviewing her allergies and any prescription drugs she might be taking could also reveal important information about the causes of the rash (Butler, n.d.). Pictures of the rash in various phases and locations may be taken for documentation and monitoring purposes.
Differential Diagnoses and Rationale
The following differential diagnoses are potentially based on the patient’s presentation and past medical history.
- Poison Ivy Dermatitis. Given the linear distribution of the rash, the itching, the vesiculopapular appearance, and the fact that she recently pulled weeds in the yard, it is probably a possibility (Kim et al., 2019).
- Contact Dermatitis. During her yard work or elsewhere, RB may have come into contact with more allergens or irritants, which triggered the inflammatory response on her arm (Dinulos, 2019).
- Herpes Zoster (Shingles). Although RB’s age is quite young for typical shingles instances, this illness can manifest as vesicles and linear dispersion.
- Scabies. Despite the absence of burrows, this highly contagious infection is important to consider because of its intense itching and linear pattern.
- Allergic Reaction. RB may have occasionally experienced an allergic reaction to a novel substance or food.
Recommended Treatment and Management Plan
The following course of treatment is advised based on the most likely diagnosis of poison ivy dermatitis.
- Topical Treatment. To relieve itching and calm the skin, use calamine lotion on the affected area three to four times daily.
- Oral Antihistamines. RB can take a once-daily dose of cetirizine 10mg, an over-the-counter antihistamine, to lessen itching and inflammation.
- Short Course of Oral Corticosteroids. If the rash is severe or spreading, a brief course of oral prednisone, such as 20 mg daily for 5 days, can be administered to control the inflammation.
Patient Education and Self-Care Instructions
Patient education is essential in the case of RB. I would advise her to avoid further contact with any suspected plants, such as poison ivy, oak, or sumac. She should also wash her skin thoroughly with soap and water after possibly coming into contact with plants to remove any remaining oils. Furthermore, she must continue using the prescribed topical medications as directed and continue using them even if the rash begins to heal.
References
Butler, D. F., MD. (n.d.). Fixed drug eruptions: Background, pathophysiology, etiology. Web.
Dinulos, J. G. H. (2019). Habif’s Clinical Dermatology E-Book. Elsevier Health Sciences.
Kim, Y., Flamm, A., ElSohly, M. A., Kaplan, D. I., Hage, R. J., Hamann, C., & Marks, J. G. (2019). Poison ivy, oak, and sumac dermatitis: What is known and what is new? Dermatitis, 30(3), 183–190. Web.