NURS 6512 WEEK 10 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.
In this Discussion, 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.
Note: Your Discussion post should be in the SOAP (Subjective, Objective, Assessment, and Plan) note format, rather than the traditional narrative style Discussion posting format. 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.
To prepare:
Review the Skin Conditions document provided in this week’s Learning Resources, and select two conditions to closely examine for this Discussion.
Consider the abnormal physical characteristics you observe in the graphics 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.
By Day 3
Post a description of the two graphics you selected (identify each graphic by number). Use clinical terminologies to explain the physical characteristics featured in each graphic. Formulate a differential diagnosis of three to five possible conditions for each. Determine which is most likely to be the correct diagnosis, and explain your reasoning.
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different days. Make sure that you respond to colleagues who selected at least one graphic that is different from the ones you selected. For each, address all of the following:
Critique your colleague’s clinical description of the physical characteristics of each.
Suggest an additional possible condition for each graphic, and explain your reasoning.
Provide an alternative correct diagnosis, and explain your reasoning.
Validate an idea with your own experience and additional research.
Week 4
Skin Comprehensive SOAP Note
Patient Initials: B.B Age: 32 years Gender: Male
SUBJECTIVE DATA:
Chief Complaint (CC): “Red patches on the beard with pus-filled pimples.” (Graphic 3)
History of Present Illness (HPI):
B.B is a 32-year-old White male with chief complaints of having red patches on the beard with pus-filled pimples. He states that the patches are on the left side of the lower beard. The patches started as acne papules about ten days ago, which later turned yellow and pus-filled. The pimples begin as papules and progress to pustules, which have proliferated over the days. The client reports that the part with the red patches is tender to touch. Besides, he experiences a mild itching sensation, and some hair plucks when he scratches the beard. He states that the beard hair on and around the red patch is brittle and lusterless. The patient mentions that he bought OTC Betamethasone cream four days ago to alleviate the itchiness and eliminate the pimples, but it has not had any effect.
Medications: OTC Betamethasone cream.
Allergies: Allergic to Sulphur- causes a rash.
Past Medical History (PMH): History of Asthma- diagnosed at 6 years. Last exacerbation at 25 years.
Past Surgical History (PSH): None
Sexual/Reproductive History: Denies history of STIs.
Personal/Social History:
B.B is married and lives with his spouse and two children aged 5 and 2 years. He has a Bachelor’s in Mass Communication and works as an editor in a publishing company. He reports taking 3-4 glasses of whiskey on his day offs but denies smoking or using drug substances. His hobbies include playing basketball and reading fictional novels. He is the captain of the basketball team in his organization and coaches the basketball team in the local high school in his free time. He reports sleeping 6-7 hours daily and eating 4-5 healthy meals daily.
Health Maintenance: The patient goes to the gym 3-4 days a week. He plays basketball on weekends. He reports attending annual wellness exams.
Immunization History:
Last Tdap- 07/2015
Influenza shot- 06/2022
COVID-19 vaccine- 03/2021 (1st dose) 05/2021 (2nd dose) AstraZeneca
Significant Family History:
The paternal great-grandfather had HTN and died from stroke at 92 years. His maternal grandmother has DM and rheumatoid arthritis. His Father has controlled HTN, diagnosed at 54 years. Siblings and children are alive and well.
Review of Systems:
General: Negative for weight changes, fever, chills, or fatigue.
HEENT: Negative for headache, double/blurred vision, excessive lacrimation, ear pain/discharge, hearing loss, nasal secretions, sneezing, or throat pain.
Respiratory: Denies cough, sputum, chest pain, or breathing difficulties.
Cardiovascular/Peripheral Vascular: Negative for lower limbs edema, palpitations, chest pain, increased fatigue, or dyspnea on exertion.
Gastrointestinal: Negative for nausea, vomiting, regurgitation, epigastric/abdominal pain, rectal bleeding, or diarrhea/constipation.
Genitourinary: Negative for blood in urine, dysuria, urinary frequency, or urgency.
Musculoskeletal: Negative for joint pain/stiffness, muscle pain, or lower back pain.
Neurological: Denies headaches, dizziness, black spells, or tingling sensations.
Psychiatric: Denies having depressive, anxiety, obsessive symptoms, or suicidal thoughts.
Skin/hair/nails: Positive for mild itching on the lower left beard area. Pus-filled pimples on the beard and red skin patches. Brittle beard hair.
OBJECTIVE DATA:
Physical Exam:
Vital signs: BP-110/68; HR- 72; RR- 16; Temp-98.2 Ht-5’7; Wt-171 lbs.
General: The client is calm, alert, and oriented. He is well-groomed and displays positive body language. He maintains eye contact and has a positive attitude towards the clinician.
HEENT: Head is symmetrical and normocephalic. Eyes: Sclera is white, and conjunctiva is pink, PERRLA. Ears: Tympanic membranes are shiny and intact. Nose: The nasal septum is intact. Throat- Tongue is pink and midline; No tooth cavities, and the Tonsillar gland is non-erythematous.
Neck: Full ROM; Trachea is well-aligned.
Chest/Lungs: Uniform and smooth respirations. The chest is clear.
Heart/Peripheral Vascular: No edema or jugular vein distention. S1 and S2 are present. No gallop sound or systolic murmur.
Abdomen: The abdomen is flat and moves with respirations. Bowel sounds are normoactive. No abdominal tenderness, masses, organomegaly, or guarding.
Genital/Rectal: Normal male genitalia. Rectal sphincter is intact.
Musculoskeletal: Full ROM in all joints; No fractures, enlarged joints, or joint tenderness/stiffness.
Neurological: Muscle strength- 5/5. Normal gait, balance, and posture.
Skin: Fair, warm, and dry skin with normal turgor. The skin at the lower left beard is inflamed with red lumpy patches. Yellow pustules and crusting on the beard involve the hair root and follicle. Broken beard hairs on the red patches.
Diagnostic results: No diagnostic results are available.
ASSESSMENT:
Tinea Barbae: Tinea barbae is a dermatophyte infection occurring in the beard area. It is characterized by superficial annular lesions. However, some patients can present with a deeper infection that resembles folliculitis (Walkty et al., 2020). Tinea barbae can also be an inflammatory kerion that causes scarring hair loss. It is typically inflamed with red lumpy areas, pustules, and crusting around the hairs. The hairs can be plucked out easily. Mild itching, irritation, or pain is often present (Walkty et al., 2020). Tinea barbae is the primary diagnosis based on positive findings of patchy red areas in the beard area with pustules and mild irritation. The brittle and easily plucked-out beard hairs also support the diagnosis.
Pseudofolliculitis Barbae: This is an irritation of the skin caused by hairs that penetrate the skin before coming out of the hair follicle or come out of the follicle and curve back into the skin, resulting in a foreign-body reaction (Ogunbiyi, 2019). Pseudofolliculitis barbae mostly occurs around the beard and neck. Clinical manifestations include an erythematous papule with a hair shaft at the center (Ogunbiyi, 2019). Pseudofolliculitis barbae is a differential diagnosis based on the pustule and erythematous patches in the patient’s lower beard.
Bacterial Folliculitis: This is a bacterial infection of hair follicles. It is mostly caused by Staphylococcus aureus, but occasionally Pseudomonas aeruginosa. Clinical manifestations include mild pruritus, pain, or irritation (Jappa & Sameer, 2018). Physical findings include a superficial pustule or inflammatory nodule around a hair follicle. The infected hairs fall out or are plucked by the patient, but new papules develop (Jappa & Sameer, 2018). The growth of stiff hairs into the skin may result in chronic low-grade inflammation or irritation. Bacterial Folliculitis is a differential based on positive symptoms of mild pruritus, papules that progress to pustules on the beard area, and beard hair that easily plucks off.
PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Jappa, L. S., & Sameer, R. K. (2018). A clinical and bacteriological study of bacterial folliculitis. Panacea Journal of Medical Sciences, 8(2), 54-58. https://doi.org/10.18231/2348-7682.2018.0014
Ogunbiyi, A. (2019). Pseudofolliculitis barbae; current treatment options. Clinical, cosmetic and investigational dermatology, pp. 12, 241–247. https://doi.org/10.2147/CCID.S149250
Walkty, A., Elgheriani, A., Silver, S., Pieroni, P., & Embil, J. (2020). Tinea barbae presenting as a kerion. Postgraduate Medical Journal, 96(1137), 441-441. http://dx.doi.org/10.1136/postgradmedj-2020-137609
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