NU-664B Week 13 Discussion Atopic Dermatitis Essay

NU-664B Week 13 Discussion Atopic Dermatitis Essay

NU-664B Week 13 Discussion Atopic Dermatitis Sample Essay

Four appropriate differential diagnoses and rationales

Atopic Dermatitis: This is a chronic inflammatory skin condition that manifests with pruritic, erythematous, and scaly skin lesions. The lesions are usually localized to the flexural surfaces of the body. The primary physical findings are dry skin, inflammation, and thickening (Frazier & Bhardwaj, 2020). The condition can present with asthma and allergic rhinitis as part of an allergic triad. Atopic Dermatitis is a possible diagnosis since the patient has extensive skin redness and pruritus and scattered scaly eczematous patches along the flexural areas of the upper and lower limbs. Besides, he has a history of asthma which is part of the allergic triad, and a family history of allergic rhinitis (Frazier & Bhardwaj, 2020). Since he has a history of similar exacerbation, he likely has an Atopic dermatitis Flare-up.

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Allergic Contact Dermatitis: It presents with pruritic papules and vesicles on an erythematous base. It is characterized by localized eczematous eruption with well-defined, geometric margins consistent with contact with an irritant or allergen. Allergic Contact Dermatitis is usually seen in the acute form but can become chronic if exposure is frequent (Nassau & Fonacier, 2020). This differential diagnosis is based on the patient’s positive symptoms of pruritus, rash, and “crust-like” lesion. However, the patient has had rash skin flares since he was four. They are not linked to contact with an allergen or irritant, ruling out Allergic Contact Dermatitis as a primary diagnosis.

Lichen Simplex Chronicus:  This is characterized by skin thickening with uneven scaling secondary to repetitive scratching or rubbing. Patients present with stable pruritic plaques on one or more areas, including the scalp, nape of the neck, extensor forearms and elbows, vulva, scrotum, and upper medial thighs, knees, lower legs, and ankles (Ju et al., 2022). Erythema occurs most in early lesions, and pruritus worsens when a person is inactive. This differential is based on the patient’s pruritus and scratching of lesions at night. Besides, the boy has lesions on the elbows and erythema consistent with Lichen Simplex Chronicus (Ju et al., 2022). However, the patient does not have uneven skin scaling secondary to repetitive scratching, which rules out this as a primary diagnosis.

Nonspecific Eczematous Dermatitis: This is characterized by lesions that progress from vesicles to weeping papules and plaques. Lichenification occurs in the chronic form of the disease. Oozing, fissuring, crusting, excoriation, or scaling may be present. Itching is also common (Chan & Zug, 2021). The lesions can occur anywhere on the body, but localized eczema mainly involves the hands or feet. The patient has crust-like serum oozing lesions, which makes this a differential diagnosis. Nonetheless, he does not have lesions progressing from vesicles to oozing papules and plaque, ruling out Nonspecific Eczematous Dermatitis as a primary diagnosis.

Plan of Care for Atopic Dermatitis

Pharmacology: 0.05% Betamethasone topical apply on the affected areas twice daily. This medium-strength topical corticosteroid for body areas reduces inflammation (Frazier & Bhardwaj, 2020). It is more potent than Hydrocortisone which was not fully effective in this patient. Topical corticosteroids are first-line agents for atopic dermatitis flare-ups.

Non-Pharmacology: Cool, moist compresses and lukewarm baths with bath additives. They are soothing, alleviate inflammation, and help débride crusts and scales (Frazier & Bhardwaj, 2020).

Labs/Diagnostics: Lab tests will only be performed if the patient’s skin becomes infected. A swab of infected skin will be taken to isolate Staphylococcus or Streptococcus) and for antibiotic sensitivity (Ahn et al., 2020).

Referrals/Interprofessional Communications: The patient will be referred to a dermatologist if the attempts to suppress the symptoms are unsuccessful and if he has frequent Atopic dermatitis flare-ups.

Patient Education (10–15 individual items minimum)

1. The patient’s caregiver will be advised to give the child frequent baths and add emulsifying oils, 1 capful added to lukewarm bath water for 5-10 minutes to hydrate the skin (Ahn et al., 2020).
2. The emulsifying oil retains the water on the skin and prevents evaporation.
3. The caregiver will be advised to apply an emollient (moisturizer) like petrolatum or Aquaphor all over the body while wet. This is to retain moisture and enable water to be absorbed through the stratum corneum (Ahn et al., 2020).
4. They will be educated to avoid applying oil-based ointments and pastes to sweaty skin fold areas to avoid maceration and blocking of pores that cause folliculitis.
5. The caregiver will be educated on measures to prevent dry skin, like the child taking low-heat showers and using emollient washes.
6. The caregiver will be educated to liberally apply emollients to the child’s entire body, whether he has active symptoms or not.
7. Emollients with high oil content but low water content will be recommended.
8. Thick creams and ointments with low water content, like Cetaphil, Eucerin, Aquaphor, and petroleum jelly, will also be recommended (Ahn et al., 2020).
9. Avoid foods that trigger acute allergic reactions, like peanuts, seafood, eggs, milk, soy, and chocolate.
10. The patient will be advised to avoid activities that result in excessive sweating.

Follow-up: A follow-up visit will be scheduled after two weeks to evaluate the client’s response to medication and assess for complications.

Social determinant of health: Neighborhood and built environment is the SDOH that the patient may face. The neighborhood where the child lives has a major impact on his health. Access to clean water is crucial in preventing recurrent skin infections. I will address this by asking the caregiver about their water source at home and if the water is clean.             If the neighborhood has unsafe water, we will discuss measures to make it safe for domestic use to prevent skin infections.

References

Ahn, K., Kim, B. E., Kim, J., & Leung, D. Y. (2020). Recent advances in atopic dermatitis. Current opinion in immunology, 66, 14–21. https://doi.org/10.1016/j.coi.2020.02.007

Chan, C. X., & Zug, K. A. (2021). Diagnosis and management of dermatitis, including atopic, contact, and hand eczemas. Medical Clinics, 105(4), 611-626. https://doi.org/10.1016/j.mcna.2021.04.003

Frazier, W., & Bhardwaj, N. (2020). Atopic dermatitis: diagnosis and treatment. American family physician, 101(10), 590-598.

Ju, T., Vander Does, A., Mohsin, N., & Yosipovitch, G. (2022). Lichen Simplex Chronicus Itch: An Update. Acta dermato-venereologica, 102, adv00796. https://doi.org/10.2340/actadv.v102.4367

Nassau, S., & Fonacier, L. (2020). Allergic Contact Dermatitis. The Medical clinics of North America, 104(1), 61–76. https://doi.org/10.1016/j.mcna.2019.08.012

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A 9-year-old boy, Taumi, with a history of recurrent skin infections presents with extensive redness and pruritus of the popliteal and antecubital fossae, arms, and abdomen. He’s scratched the lesions, especially at night, with the result that his sleep was disturbed. Despite the use of chronic moisturizing therapy and topical corticosteroids, he is having a seasonal flare of his condition. When he was 6 years old, he also experienced bronchial asthma with a persistent cough. This is not the first time he’s experienced this type of rash and has had issues since he was 4 years old. His mothers, Patricia and Fran, are bringing him into the clinic today for another exacerbation. They have tried the following: diphenhydramine 25mg q8h prn, hydrocortisone 2% QID, Zyrtec 10mg QD, and Aquaphor QID. The medications help some, but he’s still uncomfortable.
Family history: His father has asthma, and his younger sister has allergic rhinitis and cow’s milk allergy.
Physical Exam:
• Vitals: BP 102/60, HR 68, RR 18, Wt 88 lbs (22 kg), Ht 4’11”
• HEENT: Injected conjunctivae and presence of Dennie-Morgan lines. There was a ‘cobblestone’ appearance of his posterior pharynx.
• Respiratory: Lungs were clear bilaterally with good aeration.
• Cardiac and abdominal examinations were unremarkable.
• Integumentary: Skin examination demonstrated scattered scaly eczematous patches along with the flexural areas of his upper and lower extremities. Impetigo “crust-like” lesions with serum oozing were found on the left elbow.

PLEASE MAKE SURE TO COMPLETE THE FOLLOWING:

• Four appropriate differential diagnoses and rationales with references. For each differential diagnosis, explain why this is an appropriate differential and how it was/would be ruled in or out. Support your answers with references.
• Pick one differential and create a plan of care for that patient.
o Plans must include Pharmacology, Non-Pharmacology, Labs/Diagnostics, Referrals/Interprofessional Communications, Patient Education (10–15 individual items minimum) and follow up.
o Make sure to pick one health maintenance item for this patient (primary or secondary) and explain to the patient why this is important.
o Address one social determinant of the health this patient may face during your visit. How will you help the patient overcome this obstacle to health care?