Mod.2 AdvH Discussion Reply
You should respond to both discussions separately–with constructive literature material- extending, refuting/correcting, or adding additional nuance to their posts. Minimum 150 words each reply with references under each reply. Incorporate a minimum of 2 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work. Journal articles should be referenced according to the current APA style (the online library has an abbreviated version of the APA Manual). Case # 2 The patient is a 45-year-old woman that presents with a red rash on her arms and legs. She has been visiting the local YMCA for summer camp. The symptoms are two weeks old, prompting questions regarding possibly allergic, contagious, or environmental origins. A further evaluation can be helpful to clarify if the patients have been in contact with irritants, infectious pathogens, or outside allergens. One of the main presenting symptoms is the intense pruritus indicated by the rash’s macular papular lesions with secondary excoriations. The distribution on forearms, upper arms, chest, thighs, and knees are suggestive of either contact dermatitis, bug bites, or a fungal illness requiring further assessment to discard other diagnosis. More subjective information would be helpful in deciding the rash origin and etiology. Asking about changes in soap, detergent, or skin care products may identify contact dermatitis provocations. Enquiring about exposure to plants such as poison ivy or recent outdoor activities could be useful in seeking an environmental cause (Dunphy et al., 2022). The finding of similar symptoms in the camp children could be suggestive of a viral exanthem or a contagious condition, as scabies. Her history of atopic dermatitis or allergies might precondition her for particular skin responses. The timing of symptom onset may help to confirm the association with an environmental exposure if it coincided with YMCA visits. Objective information should focus on lesions, as the physical distribution and appearance can be diagnostic such as burrows in scabies, vesicles in allergic contact dermatitis and annular plaques in tinea corporis. Irradiating the rash with a Wood’s lamp (black light) may show fluorescence if fungus is present (Jarvis, 2019). The presence of palpable lymphadenopathy may suggest an infectious process. With the excoriations, look for USD or secondary bacterial infection with findings of warmth, pus, or worsening erythema. The absence of fever or systemic symptoms makes widespread infection less likely but doesn’t rule out localized processes. Diagnostic tests may also consist of a skin scraping with a KOH preparation to reveal fungal hyphae for tinea as a possible cause (Dunphy et al., 2022). Scabies preparation may be indicated if burrows are observed. Patch testing could reveal allergens where contact dermatitis is suspected but it is usually reserved for cases that are either persistent or recurrent. Bloodwork is probably not indicated unless a systemic reaction is concerned about, and a CBC might be ordered for a look at eosinophilia in allergic conditions. The three main differential diagnoses that can be considered are allergic contact dermatitis, scabies and tinea corporis. Allergic contact dermatitis fits due to a pruritic, erythematous rash involving exposed areas. Read More …