Differntial Diagnosis for Skin Conditions
For this post I have selected these two graphics: #5 and #4. For each of these
selections I will describe the graphic and explain the physical characteristics found
therein, in clinical terminology, as supported by citations to current readings. I will
formulate a differential diagnosis of 3 to 5 possible conditions, and select the most likely
diagnosis, based on the current research-based literature.
Graphic #5
Patient Initials: XT
Age: 25
Gender: FEMALE
SUBJECTIVE DATA: Include what the patient tells you, but organize the information.
Chief Complaint (CC): Itchy rashes
History of Present Illness (HPI): The patient, XT, is a 25-year old Caucasian
female, who presented a complaint of itchy rashes on her skin – specifically on
the neck, legs, and face. In addition to itchiness, the rashes had changed their
color and thickened. There were present in a huge amounts especially on the
neck and according to her, she has had the condition for the last 9 months.
Always, the condition has been manageable but got worse recently after she
used a bathing soap in a hotel outside the country. The itchiness of the illness
seemed to be really tough on the patient.
Medications:
Prednisone 30mg once daily.
Hydrocortisone Topical Dosage applied three times daily
Turmeric powder, 1 tablespoon in food daily
Allergies:
None reported/none known.
Past Medical History (PMH):
1. Asthma
2. Ulcers
3. Survived a road accident
Past Surgical History (PSH): None
Sexual/Reproductive History:
She lives with her fiancée with whom she is sexually active
Personal/Social History:
XT has never smoked but does occasionally drink wine or alcohol. She also does
not consume any recreational drugs. She is very active physically, often
engaging in evening walks within her town and also swimming sessions.
Immunization History:
Has received vaccines against tetanus, tuberculosis and polio – on her trip to
Kenya
Significant Family History:
Her parents do have a healthy record so does her siblings and grandfather.
Records however show that her grandmother had a variety of skin conditions
which included eczema.
Lifestyle: Miss XT belongs to the catholic faith and frequently attends masses at
the local cathedral. She just completed her studies and is on attachment at a
local industry. She lives with her fiancée, a lawyer, who frequently offers financial
as well as emotional support. XT has is comfortable with her fiancée being
involved in decision-making with regards to her health. She likes dancing and
hence often visits a theatre close to her home.
Review of Systems: From head-to-toe, include each system that covers the
Chief Complaint, History of Present Illness, and History (this includes the
systems that address any previous diagnoses). Remember that the information
you include in this section is based on what the patient tells you so ensure that
you include all essentials in your case (refer to Chapter 2 of the Sullivan text).
General: Miss XT enjoys physical activity a lot including swimming and dancing.
She has also follows the appropriate diet. Her weight has therefore been
constant, at a recommended level. She also has had no weaknesses or fatigue
of late.
HEENT:
Neck:
Apart from the rashes, there was no complaint with regards to her
neck
Breasts: No breast complaint noted
Respiratory: Some asthma attacks have occurred but they are not very frequent
and she has sufficient inhalers to combine it
Cardiovascular/Peripheral Vascular: No complaints noted
Gastrointestinal: She stated that she had some diarrhea recently which she
contained appropriately. Other than that, she has no other complaint in this
section.
Genitourinary: She has no complaints here
Musculoskeletal: There is no hindrance of motion, joint pains, swellings as well
as a history of gout or arthritis
Psychiatric: Disorders such as anxiety, depression, suicidal thoughts, homicidal
thoughts as well as any suicidal thoughts are all absent
Neurological: There was no complaint here
Skin: Presence of rashes which are very itchy and have changed their
complexion over time. Dry and scaly skin which also had redness was
complained of. Rashes behind ears had also been noted.
Hematologic: No issues reported
Endocrine: No issues reported
Allergic/Immunologic: Dusty conditions could trigger the asthma
OBJECTIVE DATA:
Physical Exam:
Vital signs: B/P 120/68, Wt: 120 Ibs, Ht: 5’4, BMI: 20.6
General: XT answered questions very positively and appropriately. She could
also move very easily but her sweaty smell could be easily felt. Hence, her
mental condition was healthy enough but the smell could be due to difficulty in
taking showers due to her skin condition.
HEENT: Patent external auditory canal, sinuses are tender and oropharynx clear
Neck: Easy movement, supple, trachea is located at the midline, rashes present,
and little lymph node enlargement
Chest/ Lungs: Easy breathing, symmetrical chest movement, and clear breathe
sounds
Heart/ Peripheral Vascular: no murmurs, rubs or gallons with RRR, no
peripheral edema and abdominal aorta bruit, 2+ distal pulses
Neurological: Alert and oriented. CN II – XII grossly intact. Mood and affect
appropriated for situation
Skin: Nodes: No, clubbing, cyanosis or edema; Noted multiple bright red
papules in the trunk, no palpable nodes.
ASSESSMENT:
Lab Tests and Results: N/A
Diagnostics: N/A
Graphic #5 contains rashes that have redness, seems to have heightened width, and
also seems scaly. The differential diagnoses for the graphic include eczema, plant
rashes, or hives. The highly probable diagnosis is eczema since it is a condition that
results in some rashes on the skin that are red in color, scaly conditions, and itchiness.
The graphic does indeed seem itchy and the width of the rashes does seem extended.
It is also worth mentioning that eczema can occur in people of whatever age, including
XT (Kim et al., 2016).
Graphic #4
Patient Initials: DV
Age: 42
Gender: MALE
SUBJECTIVE DATA: Include what the patient tells you, but organize the information.
Chief Complaint (CC): Presence of stalks on skin
History of Present Illness (HPI): The patient is a 42-year old Caucasian man
who had a complaint of the development of growths that were up to five
centimeters long on their chest or neck. The tags were slightly darker than the
rest of the skin and had occurred over the last three months. They were not
painful in any way but the patient was worried because of self-esteem.
Medications: bichloroacetic/trichloroacetic acid
Salicylic acid applied after a bath on a daily basis
Allergies: None.
Past Medical History (PMH): In his teenage years, was suffering from
tuberculosis
Past Surgical History (PSH): Has not received any surgery
Sexual/Reproductive History: He is married and hence sexually active with his
wife
Personal/Social History: Regularly drinks and smokes, plays football
occasionally
Immunization History: Recently got a vaccine against yellow fever and flu.
Significant Family History: All family members are ok, except for his mother
who has got well-managed diabetes
Lifestyle: As earlier mentioned, the patient is married, He works as an
accountant and hence is financially stable and has a good supportive relationship
with his wife.
Review of Systems:
General: constant weight, no reports of fatigue, fever or lack of sleep.
HEENT: HEENT: Denies any loss of vision, double vision, glaucoma,
excessive tearing, or photophobia He has the history of iritis and the last
eye examination was 3 years ago. Mr. DV denies any recent ear
infections, tinnitus, or discharge from the ears. He reported her sense of
smell is intact. No history of any nose-bleed, nasal polyp, sinus infection.
Mr. X will see the dentist twice a year and his last dental exam last month.
He denies any ulceration, lesions,
Neck: Normal functioning, no complaint
Breasts: No complaint
Respiratory: Functioning well since TB completely healed
Cardiovascular/Peripheral Vascular: No complaint
Gastrointestinal: No nausea, vomiting or changes in bowel activity
Genitourinary: Despite his sexual activity, DV does not and has never
had any STD and there is no penile discharge
Musculoskeletal: No complaint
Psychiatric: No complaint
Neurological: No complaint
Skin: Apart from the tags, everything seems ok
Hematologic: No complaint
Endocrine: No complaint
Allergic/Immunologic: None
OBJECTIVE DATA:
Physical Exam:
Vital signs:, Ht 6’2, Wt 175 Ibs, and BMI 22.5.
General: DV is occasionally physically active. Plays football occasionally. He
follows the appropriate diet. His weight has therefore been constant, at a
recommended level. There are no weaknesses or fatigue experienced of late.
HEENT:
Neck: No pain or injury, just the tags
Chest: No pain or injury, just significant amount of tags
Skin: Worried about tags
ASSESSMENT: Graphic # 4 represents DV’s condition. It represents a growth on his
skin which is not painful in any way. The differential diagnosis are: skin tags, warts, or
moles. All these conditions do occur as growths anywhere on the skin. The most likely
diagnosis would be skin tags. This condition entails growths on the skin that are not in
any way painful or harmful (Shenoy, Shenoy, Krishna, & Pinto, 2016). The patient has
not complained of any pain and hence it is likely skin tags. It is also worth mentioning
that the tags are not very different in terms of color from the skin.
References
Kim, H., Zhou, H., Kim, J. H., Habre, R., Bastain, T. M., & Gilliland, F. D. (2016).
Lifetime prevalence of childhood eczema and the effect of indoor environmental
factors: Analysis in Hispanic and non-Hispanic white children. Allergy and
Asthma Proceedings, 37(1), 64-71. doi:10.2500/aap.2016.37.3913
Shenoy, M., Shenoy, C., Krishna, S., & Pinto, M. (2016). Skin tags are not merely
cosmetic: A study on its association with metabolic syndrome. International
Journal of Health & Allied Sciences, 5(1), 50. doi:10.4103/2278-344x.173882