WEEK*2 IHUMAN CASE STUDY 36 YEAR OLD FEMALE CLASS 6531 REASON FOR ENCOUNTER:ITCHY RASH (HI, Exams of Nursing

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WEEK*2 IHUMAN CASE STUDY 36 YEAR OLD FEMALE CLASS 6531 REASON FOR ENCOUNTER:ITCHY RASH

(HIGHLIGHTED IN RED)LOCATION: OUTPATIENT CLINIC WITH LABORATORY CAPABILITIES

NEWEST 2025

 Title : "iHuman Case 36 Year Old Female"

 Reason for Encounter : Itchy Rash (highlighted in red)

 Affected Areas : Inner thighs and left inner forearm

 Case Details :

 36-year-old female  Height: 5'0" (152 cm)  Weight: 144.8 lb (65.5 kg)  Case is part of i-Human Case Week #  Mode: Learning mode with feedback after each section  Location: Outpatient clinic with laboratory capabilities  Attempts available: 1

1. Chief Complaint

 Primary issue: Itchy rash on inner thighs and left inner forearm  Onset: When did the rash first appear?  Duration: Has it been persistent or intermittent?  Progression: Has it worsened or spread over time?

2. History of Present Illness (HPI)

 Triggers: Any new soaps, lotions, detergents, or clothing?  Seasonal or environmental factors: Any recent travel, outdoor activities, or exposure to allergens?  Symptoms: Is there redness, scaling, pain, swelling, or discharge?  Relieving/aggravating factors: Does anything make it better or worse (e.g., scratching, heat, cold, moisturizers)?  Associated symptoms: Fever, fatigue, joint pain, or other skin changes?  Previous episodes: Has this happened before? If so, when and how was it treated?

3. Past Medical History (PMH)

 Any history of eczema, psoriasis, allergies, asthma, or autoimmune diseases?  Any chronic illnesses like diabetes (which can predispose to fungal infections)?

4. Medications & Allergies

 Any new medications?  Any known allergies (e.g., food, drugs, environmental triggers)?

5. Family History

 Any family members with skin conditions like eczema, psoriasis, or autoimmune diseases?

 Does the patient appear well or ill?  Any signs of fever, distress, or discomfort from itching?

2. Vital Signs (to rule out systemic illness)

 Temperature – Any fever (suggests infection or inflammatory process)?  Heart rate & blood pressure – Any abnormalities?  Respiratory rate – Any shortness of breath (could suggest an allergic reaction)?

3. Skin Examination (Primary Focus)

Inspection:

 Location & distribution – Rash on inner thighs and left inner forearm  Color – Red, pink, brown, or violaceous?  Shape & borders – Well-demarcated, irregular, linear, circular?  Texture – Scaly, smooth, rough, moist, or dry?  Lesion type: o Macules (flat spots) – Could suggest viral exanthem or allergic reaction o Papules (raised bumps) – Think of eczema, scabies, or folliculitis

o Plaques (large raised areas) – Consider psoriasis o Vesicles or bullae (fluid-filled lesions) – Could be herpes, dermatitis herpetiformis, or contact dermatitis o Pustules (pus-filled lesions) – Suggests infection (bacterial folliculitis, fungal infection) o Scaling or crusting – Fungal infection (tinea), eczema, or impetigo o Excoriations (scratch marks) – Indicates intense itching (pruritus) o Lichenification (thickened skin from chronic scratching) – Suggests chronic eczema or atopic dermatitis  Symmetry – Is the rash on both sides of the body (suggests systemic cause) or asymmetric (more likely external exposure)?  Signs of secondary infection – Pus, warmth, tenderness, lymph node swelling?

Palpation:

 Warmth – Infection or inflammation?  Texture – Rough (eczema, psoriasis), soft, firm?  Tenderness – Suggests infection or inflammation

4. Mucosal Exam (Mouth, Eyes, Genital Area)

Finding Possible Diagnosis (tinea)

Well-demarcated plaques with silvery scale Psoriasis

Circular rash with central clearing Ringworm (tinea corporis)

Vesicles or blisters on erythematous base Herpes simplex, allergic reaction

Linear streaks of rash Poison ivy, contact dermatitis

Intense itching at night, burrows in skin Scabies

Rash + fever or systemic symptoms Viral exanthem, autoimmune disease

Assessment for 36-Year-Old Female with Itchy Rash

Summary of Case:

A 36-year-old female presents with an itchy rash localized to her inner thighs and left inner forearm. No systemic symptoms have been reported yet. The history and physical exam findings will guide the differential diagnosis.

Differential Diagnoses (Top Possibilities)

⃣ Contact Dermatitis (Irritant or Allergic)

 Key Features: o Rash localized to areas of direct exposure o Red, itchy, possibly blistering or scaling o May worsen with new skincare products, detergents, jewelry, or occupational exposures  Supporting Clues: History of new exposures, improvement after avoiding suspected irritants

⃣ Atopic Dermatitis (Eczema)

 Key Features: o Chronic, relapsing itchy rash o Common on flexural surfaces (inner forearm, behind knees, neck) o Personal or family history of allergies, asthma, or hay fever  Supporting Clues: Dry, scaly, lichenified patches, history of childhood eczema

⃣ Tinea Corporis (Fungal Infection, "Ringworm")

 Key Features: o Circular, well-demarcated rash with central clearing and scaly edges o Can be found on inner thighs, arms, or trunk

Diagnostic Workup:

✅ Clinical Diagnosis (If presentation is clear, no tests may be needed) ✅ Tests to Consider Based on Findings:

 KOH prep & fungal culture – If suspecting tinea (ringworm)  Skin scraping for scabies mites – If suspecting scabies  Patch testing – If suspecting allergic contact dermatitis  Skin biopsy (rare cases) – If unable to confirm diagnosis clinically

Treatment Plan (Depends on Diagnosis)

✅⃣ Contact Dermatitis (If suspected)

 Avoid trigger (soaps, lotions, clothing materials)  Topical corticosteroids (e.g., hydrocortisone, triamcinolone)  Oral antihistamines for itching (e.g., diphenhydramine, loratadine)

✅⃣ Atopic Dermatitis (If suspected)

 Moisturizers (fragrance-free, thick creams like CeraVe, Eucerin)  Topical steroids (low potency for mild cases, stronger for flares)

 Avoid hot showers & harsh soaps

✅⃣ Tinea Corporis (If suspected)

 Topical antifungal (clotrimazole, terbinafine) for mild cases  Oral antifungals (fluconazole, terbinafine) for severe or widespread cases  Avoid tight clothing, keep skin dry

✅⃣ Scabies (If suspected)

 Permethrin 5% cream applied to the whole body overnight  Wash all bedding and clothing in hot water  Treat close contacts even if asymptomatic

✅⃣ Psoriasis (If suspected)

 Topical corticosteroids  Vitamin D analogs (calcipotriol)  Referral to dermatology if severe

Follow-Up Plan:

⃣ Patch Testing (For Allergic Contact Dermatitis)

 Positive result: o Localized reaction (redness, swelling, blistering) at test sites o Confirms allergic reaction to specific agents (e.g., nickel, fragrances, latex, preservatives).  Negative result: Rules out allergic contact dermatitis.

⃣ Complete Blood Count (CBC) & Eosinophil Count

 Elevated eosinophils (>5%) → Suggests allergic reaction (eczema, contact dermatitis, or scabies).  Elevated white blood cells (WBCs) → Possible secondary bacterial infection (impetigo, cellulitis).

⃣ Skin Biopsy (For Psoriasis, Dermatitis, or Unclear Cases)

 Findings for Atopic Dermatitis: Spongiosis (fluid between skin cells), inflammation.

 Findings for Psoriasis: Acanthosis (thickened epidermis), parakeratosis (abnormal keratinization), Munro’s microabscesses (clusters of neutrophils).  Findings for Contact Dermatitis: Epidermal edema and inflammatory infiltrates.  Findings for Scabies: Presence of mite burrows or inflammatory response.

Summary of Expected Results Based on Diagnosis

Test

Tinea (Ringworm) Scabies^

Contact Dermatitis

Atopic Dermatitis Psoriasis

KOH Prep + (hyphae) - - - -

Skin Scraping - + (mites) - - -

Patch Testing - - + - -

CBC (Eosinophils)

Normal ↑ ↑ ↑ Normal

Skin Biopsy

Fungal elements

Mites or burrows

Spongiosis Epidermal edema

Acanthosis

Diagnosis: Contact Dermatitis vs. Tinea Corporis vs. Scabies

Differential Diagnoses (Other Possible Conditions)

✅ Tinea Corporis (Fungal Infection, "Ringworm")

 Key Features: o Circular rash with central clearing and scaly border. o Positive KOH prep (shows fungal hyphae). o Commonly spreads from pets, people, or shared items.  Diagnostic Test: o KOH prep & fungal culture → Positive for dermatophytes.

✅ Scabies (Less Likely but Considered)

 Key Features: o Intense nighttime itching. o Linear burrows in web spaces, wrists, and body folds. o Multiple close contacts with similar symptoms.  Diagnostic Test: o Skin scraping → Positive for mites, eggs, or fecal pellets.

Final Decision & Treatment Plan

➡✅ If Contact Dermatitis:

 Avoid triggers (fragrances, detergents, lotions).  Topical steroids (hydrocortisone, triamcinolone for severe cases).  Oral antihistamines for itching (loratadine, diphenhydramine).  Moisturizers to repair skin barrier.

➡✅ If Tinea Corporis (Ringworm) Confirmed:

 Topical antifungals (clotrimazole, terbinafine).  Oral antifungals (for widespread cases).

➡✅ If Scabies Confirmed:

 Permethrin 5% cream (apply overnight, repeat in 1 week).  Wash bedding/clothes in hot water.  Treat close contacts.

Plan for 36-Year-Old Female with Itchy Rash

⃣ General Approach Based on Diagnosis