Differentials for the Patient
Patient K.B., 30 years old, complains of itching and flaking of the scalp and knees, as well as problems with sleep and concentration that are not characteristic of her. Based on a detailed survey, the first diagnosis is dermatitis, characterized by inflammation and damage to the structural tissues of the skin as a result of exposure to adverse factors. Typical symptoms are burning, itching, redness of the skin, and a rash (Montero‐Vilchez et al., 2021). The irritant can be mechanical stress, excessive ultraviolet exposure, or a specific allergen (Montero‐Vilchez et al., 2021). Thus, the most common cause of the disease is a negative external effect.
It can also lead to a second diagnosis, namely, an adverse reaction to the patient’s medications for the treatment of hypertension. Side effects of lisinopril, in addition to dry skin and rashes, include symptoms such as weakness, which may cause the patient to have trouble concentrating. In addition, loratadine can also cause sleep problems, so an allergic reaction to medications taken is the second differential diagnosis. The third diagnosis is psoriasis, the symptoms of which are manifested in redness, scales, and itching of the scalp or other affected areas (Rendon & Schäkel, 2019).
Most Concerned Medical Diagnose
Psoriasis can significantly impair the patient’s quality of life, especially if the musculoskeletal system is involved in the pathological process, as, for example, on the knees of K.B. In addition, psoriasis tends to spread quickly, and delayed treatment can lead to large areas of skin being affected. Psoriasis does not affect other putative diagnoses but rather may result from the development of others. For example, psoriasis may develop due to an allergic reaction.
Diagnostic Images
Dermoscopy is a method of instrumental examination of the skin in which the type of rash can be determined. The results of this procedure are required to exclude other diseases manifested by skin changes. A skin biopsy is the most effective method for detecting various dermatological conditions (Rendon & Schäkel, 2019). First of all, this is aimed at eliminating suspicions of psoriasis in order to choose the right treatment. At the initial stage of the disease, when only the skin is slightly affected, therapy is immediately prescribed after an examination. Additional studies will be required if the joints are involved or there is a suspicion of concomitant immune endocrine disorders.
Laboratory Work
Before starting treatment, laboratory tests are necessary, including a general (clinical) blood test, a general urinalysis, and a biochemical blood test: total bilirubin, AST, ALT, cholesterol, triglycerides, and total protein (Murzina, 2020). The analysis will provide insight into the possible allergens that may have manifested in K.B.’s disease. In addition, a urine test will determine the water balance, the violation of which can be caused by dehydration with extensive skin lesions. Since the skin diseases suspected in the patient do not change the blood composition by themselves, I would suggest an allergic reaction to the drugs.
Comprehensive Plan of Care
Only a specialist can difference psoriasis from other diseases masquerading as it is by the typical symmetrical arrangement of lesions and the type of wounds, so it is necessary to refer the patient to a dermatologist. Topical therapy involves topical corticosteroid preparations in the form of ointments, creams, or lotions (Topical corticosteroids, 2020). The health of the skin is directly dependent on the lifestyle of the patient, so prevention methods help avert the development of the disease. It is recommended to wear clothes made from natural fabrics, use hypoallergenic cosmetics, and carry out moderate water procedures. It is necessary to exclude contacts with possible allergens, limit stressful situations, and use neutral detergents (Montero‐Vilchez et al., 2021). In order to increase the period of achieved remission and prevent relapses, it is necessary to adhere to the rules of hygiene, avoid stress, take medications with caution, and take care of the skin.
References
Montero‐Vilchez, T., Cuenca‐Barrales, C., Martinez‐Lopez, A., Molina‐Leyva, A., & Arias‐Santiago, S. (2021). Skin adverse events related to personal protective equipment: A systematic review and meta‐analysis. Journal of the European Academy of Dermatology and Venereology, 35(10), 1994–2006. Web.
Murzina, E. (2020). Biochemical indicators and course of dermatosis in children with psoriasis depending on the body mass index. ScienceRise: Medical Science, 6(39), 45–49. Web.
Rendon, A., & Schäkel, K. (2019). Psoriasis pathogenesis and treatment. International Journal of Molecular Sciences, 20(6), 1475. Web.
Topical corticosteroids. NHS. (2020). Web.