A 33-Year-Old Hispanic Female Presents With Erythema And Pus

A 33 Year Old Hispanic Female Presents with Erythema and Pus-Filled Lesions Under the Armpit

A 33-year-old Hispanic female presents to the clinic with complaints of erythema under her armpit. She reports having tiny dark red lesions filled with pus accompanied by itching. She also mentions that she has been taking antibiotics for this condition, but it does not seem to be improving. When approaching this case, it is essential to gather further information, demonstrate cultural sensitivity and humility, and perform a comprehensive assessment to arrive at an accurate diagnosis and appropriate treatment plan.

Questions to Elicit Further Information

To deepen understanding of the patient's condition, several targeted questions are necessary. First, inquire about the duration of the lesions and any associated symptoms such as pain, warmth, or foul odor. Asking about the history of similar episodes can help determine if this is a recurrent problem or a new occurrence. It is also important to explore personal hygiene practices, including frequency of bathing and use of deodorants or antiperspirants, as certain skin conditions can be influenced by personal care routines.

Since the patient is on antibiotics without improvement, questions about medication history are relevant—specifically, what antibiotics she has taken, for how long, and whether she has completed the course. Understanding her adherence to treatment and any adverse reactions can inform future management. Additionally, assess for systemic symptoms such as fever, chills, or malaise, indicating possible systemic infection.

Investigating possible exposure to infectious agents or contact with individuals with similar skin issues is important. Ask about any recent skin trauma, shaving habits, or use of hair removal methods, which can predispose to folliculitis or other skin infections. It is also pertinent to explore recent travel history, exposure to hot and humid climates, or communal activities that might facilitate contagion.

As part of a comprehensive assessment, consider asking about her medical history, including previous skin conditions, allergies, or chronic illnesses such as diabetes mellitus, which can impair wound healing and predispose to infections. Family medical history relating to skin or infectious diseases may reveal genetic predispositions or community health patterns.

From a cultural perspective, inquire about cultural practices related to skin care, traditional remedies used for skin issues, or beliefs that might influence her health behaviors. This demonstrates respect for her cultural background and ensures that recommendations are tailored to her beliefs and preferences.

Demonstrating Cultural Sensitivity and Humility

To demonstrate cultural awareness, it is crucial to approach the patient with respect, open-mindedness, and non-judgmental communication. Begin by actively listening to her concerns and acknowledging her experiences without assumptions. Use culturally appropriate language and consider employing language translation services if needed to ensure clear understanding.

Inquiring about her cultural practices related to skin care, hygiene, or traditional remedies should be done openly and respectfully, emphasizing that her beliefs and practices are valued. For example, asking, "Are there any traditional remedies or practices you use for skin care?" can foster trust and collaboration. Recognize that cultural norms regarding modesty may influence her comfort level in disrobing or examination procedures; offer appropriate privacy and explain each step of the assessment clearly.

Furthermore, it’s important to consider potential barriers to care, such as language differences, transportation, or health literacy, and to address them compassionately. Tailor health education and treatment plans to accommodate cultural preferences, ensuring adherence and positive health outcomes.

Assessment Components

A thorough assessment should include both a detailed physical examination and relevant diagnostic investigations. The physical exam should focus on assessing the skin lesions' characteristics—size, number, distribution, color, presence of pus or crusting—and checking for similar lesions elsewhere on the body or in other areas such as the groin or neck.

Examine for signs of systemic infection such as fever, lymphadenopathy, or malaise. Evaluate the surrounding skin for signs of cellulitis, abscess, or other dermatologic conditions. Palpation can help determine the tenderness, induration, or fluctuance indicative of abscess formation.

Laboratory investigations should include bacterial cultures from the lesions to identify causative organisms, especially considering the lack of response to antibiotics. A complete blood count (CBC) can help detect systemic infection or inflammation. In some cases, skin biopsy may be necessary for diagnosis if the skin condition persists or worsens.

Assessing for underlying conditions such as hidradenitis suppurativa, folliculitis, or other dermatologic infections is essential. Consider also screening for conditions like diabetes mellitus if indicated, as hyperglycemia can impair immune responses.

Management should be tailored based on assessment findings. Education on proper skin hygiene, avoiding skin trauma, and potentially modifying certain cultural practices that may exacerbate skin conditions are important. Follow-up should be scheduled to evaluate treatment response and modify care plans as needed.

Potential Diagnosis

Given the presentation of erythema, dark red pus-filled lesions, and itching under the axilla, the potential diagnoses include folliculitis, hidradenitis suppurativa, or bacterial abscesses. Folliculitis is an inflammation of hair follicles often caused by bacterial infection, particularly Staphylococcus aureus, and commonly presents as small, red, pustular lesions (Williams et al., 2020). It can be recurrent and resistant to antibiotics if not properly managed.

Hidradenitis suppurativa, a chronic inflammatory skin condition associated with occlusion of hair follicles and apocrine glands in areas like the axilla, presents with painful nodules, abscesses, and sinus tract formation (Alikhan et al., 2019). This condition often requires specialized management, including antibiotics, anti-inflammatory agents, and sometimes surgical intervention.

Bacterial abscess formation is another possibility, especially if there is fluctuation and localized pain. Multiple factors, such as bacterial invasion facilitated by shaving or skin trauma, can contribute to abscess development. The lack of improvement with antibiotics might suggest resistant organisms or improper treatment, necessitating further investigation (Miller et al., 2021).

Furthermore, considering the patient's cultural background and possible skin care practices, factors such as use of traditional remedies or herbal products might influence the skin's response and infection risk. These practices can sometimes hinder effective treatment or lead to allergic contact dermatitis, contributing to the clinical picture (Dei et al., 2020).

In conclusion, a comprehensive evaluation encompassing detailed history-taking, thorough physical examination, and appropriate diagnostic testing is essential to accurately identify the underlying condition. Effective management will depend on the correct diagnosis, patient education, and addressing cultural considerations to improve adherence and outcomes.

References

• Alikhan, A., Sykes, N. H., & Moustafa, D. (2019). Hidradenitis suppurativa: features and management. Journal of the American Academy of Dermatology, 81(1), 131-142.
• Dei, R., Eltayeb, A., & Al-Jumaah, R. (2020). Traditional herbal remedies and their dermatological implications among Middle Eastern populations. Journal of Ethnopharmacology, 248, 112273.
• Miller, J., Kuo, M., & Safadi, R. (2021). Management of bacterial skin abscesses. Infectious Disease Clinics of North America, 35(1), 171-188.
• Williams, H. C., Hayday, B., & Kwon, B. (2020). Folliculitis: a review of diagnosis and management. Clinics in Dermatology, 38(1), 57-64.