Week 4 Lab Assignment: Differential Diagnosis For Ski 102173

Week 4 Lab Assignment: Differential Diagnosis for Skin Conditions

Identify the core assignment: Create a comprehensive SOAP note for a patient presenting with skin conditions, including subjective data, objective data, assessment, and brief plan (excluding the plan section for future courses). The note should include thorough documentation of the patient's history, physical examination, and differential diagnoses supported by evidence and guidelines. Incorporate relevant medical, family, social histories, and review of systems, focusing on skin-related issues. The note must be well-organized, detailed, and demonstrate clinical reasoning in formulating differential diagnoses based on the skin condition presented.

Sample Paper For Above instruction

Title: Differential Diagnosis for Skin Conditions - SOAP Note

Introduction

The accurate diagnosis of skin conditions requires a comprehensive approach that integrates thorough patient history, detailed physical examination, and appropriate diagnostic evaluation. Skin lesions are common presenting complaints in clinical settings and can be manifestations of a wide range of dermatological and systemic diseases (Bolognia et al., 2018). This paper presents a detailed SOAP note for a hypothetical patient presenting with a skin lesion, illustrating the process of forming differential diagnoses supported by current evidence and guidelines.

Subjective Data

The patient, a 45-year-old Caucasian female, presents to the clinic with a chief complaint of a persistent skin rash on her right forearm. She reports that the rash appeared approximately two weeks ago without any recent injury. She describes the lesion as an erythematous, scaly patch that is slightly raised and mildly itchy. The patient reports no associated pain or systemic symptoms such as fever or fatigue. She notes that the rash tends to worsen with exposure to sunlight but improves when she applies over-the-counter hydrocortisone cream. She denies any new medications, recent travel, or exposure to new detergents.

The patient reports a past medical history of seasonal allergic rhinitis but no previous skin conditions. She is not on any prescription medications currently. Her allergy history includes reactions to pollen and pet dander. She is a non-smoker and consumes alcohol socially. She works as an administrative assistant and reports moderate sun exposure during her daily commute. No recent changes in her personal or social habits are noted. Her family history is significant for her mother having psoriasis.

Review of systems reveals no fever, weight loss, or systemic complaints. She denies recent sexual activity or new sexual partners. She reports no recent insect bites or exposure to potential skin irritants.

Objective Data

Vital signs are within normal limits: temperature 98.6°F, blood pressure 120/78 mm Hg, pulse 72 bpm, respiratory rate 16/min. Physical examination reveals an isolated, well-demarcated, erythematous, scaly plaque measuring approximately 5 cm in diameter located on the dorsal aspect of the right forearm. No crusting, pustules, or vesicles are observed. The lesion appears slightly raised with characteristic silvery-white scales. Surrounding skin is unremarkable. No lymphadenopathy noted. The rest of the skin examination is unremarkable, with no other lesions or rashes evident. Examination of nails, hair, and mucous membranes shows no abnormalities.

Assessment

The primary concern is a dermatological condition presenting as a well-demarcated, erythematous, scaly plaque. Differential diagnoses include:

  • Psoriasis Vulgaris: Characterized by well-demarcated, erythematous plaques with silvery scales; common on extensor surfaces; often chronic with recurrent episodes (Boehncke & Schön, 2015).
  • Actinic Keratosis: Rough, scaly patches caused by sun damage; usually on sun-exposed areas; tends to be smaller and less well-defined (Yu & Thorne, 2017).
  • Seborrheic Dermatitis: Greasy, scaly patches often on scalp, face, or chest; less sharply demarcated; may be asymmetric (Schmidt & Gollnick, 2010).
  • Lupus Erythematosus (Discoid): Chronic, scaly, erythematous plaques with potential for scarring; commonly on sun-exposed areas (Miller et al., 2014).

Further diagnostics are warranted, including skin biopsy, to confirm diagnosis, especially to differentiate psoriasis from other dermatoses. Additionally, considering the family history of psoriasis, this increases the likelihood of psoriasis vulgaris being the correct diagnosis.

Discussion of Differential Diagnoses

Psoriasis vulgaris is the leading diagnosis based on clinical presentation. It often manifests as sharply demarcated plaques with silvery scales, commonly affecting extensor surfaces such as elbows, knees, and forearms (Boehncke & Schön, 2015). The patient's description and exam findings support this diagnosis; however, confirmation with a skin biopsy demonstrating acanthosis, parakeratosis, and Munro microabscesses is essential (Nestle et al., 2009).

Actinic keratosis must be considered given sun exposure history, but the lesion's morphology and distribution are more characteristic of psoriasis. Nevertheless, being a premalignant condition, histological evaluation aids in differentiation (Yu & Thorne, 2017).

Seborrheic dermatitis is less likely due to the lesion's location and description but should be considered if lesion characteristics change or additional lesions develop. It often involves sebaceous areas with greasy, yellowish scales (Schmidt & Gollnick, 2010).

Lupus erythematosus presenting as discoid plaques is possible but less likely given lack of systemic symptoms or mucocutaneous involvement. Nonetheless, serologic studies and biopsy findings could assist in excluding this diagnosis (Miller et al., 2014).

Recommended Diagnostic Workup

  • Skin biopsy for histopathologic examination to confirm psoriasis or rule out other dermatoses.
  • Serologic tests such as antinuclear antibody (ANA) to evaluate for lupus if suspicion arises.
  • Other tests include potassium hydroxide (KOH) prep if fungal infection is suspected, although less likely here.

Conclusion

Based on the clinical presentation and family history, the most probable diagnosis is psoriasis vulgaris. Confirmatory biopsy and further testing are necessary to validate this diagnosis. An accurate diagnosis will guide appropriate treatment strategies, including topical therapies like corticosteroids, vitamin D analogs, and phototherapy, with consideration for systemic treatment in severe cases (Gottlieb et al., 2017). Monitoring and patient education regarding disease management and triggers are vital components of holistic care.

References

  • Boehncke, W. H., & Schön, M. P. (2015). Psoriasis. The Lancet, 386(9997), 983-994.
  • Bolognia, J. L., Schaffer, J. V., & Cerroni, L. (2018). Dermatology (4th ed.). Elsevier.
  • Gottlieb, A. B., Wisniewski, A., & Bagel, J. (2017). Psoriasis: Overview and treatment options. Journal of the American Academy of Dermatology, 77(1), 32-52.
  • Miller, K. A., & Mihailovic, T. (2014). Cutaneous lupus erythematosus. Dermatologic Clinics, 32(4), 601-615.
  • Nestle, F. O., Simpson, M. A., & Klein, R. (2009). The immunopathogenesis of psoriasis. The Journal of Investigative Dermatology, 129(1), 7-10.
  • Schmidt, E., & Gollnick, H. P. (2010). Seborrheic dermatitis. Journal der Deutschen Dermatologischen Gesellschaft, 8(10), 690-695.
  • Yu, R., & Thorne, M. (2017). Actinic keratosis: Management and prevention. Clinical and Experimental Dermatology, 42(8), 983-989.
  • Guttman-Yassky, E., & Lebwohl, M. (2021). Recent advances in psoriasis management. Journal of the American Academy of Dermatology, 85(2), 302-317.
  • Clark, R., & Walker, S. (2015). Diagnosing skin conditions: A clinical approach. British Journal of General Practice, 65(640), 394-395.
  • Smith, M., & Johnson, L. (2019). The role of biopsy in dermatology. Cutis, 104(4), 238-244.

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