Case Study: A 46-year-old male presents to the office complaining of a pruritic skin rash

Case Study: A 46-year-old male presents to the office complaining of a pruritic skin rash

Case Study: A 46-year-old male presents to the office complaining of a pruritic skin rash

NURS 6531 Case Study 1

A 46-year-old male presents to the office complaining of a pruritic skin rash that has been present for a few weeks. He initially noted the rash on his feet, but it then spread to between the fingers, his wrist, and waist. He notes that it does not seem to be on his face or trunk. He recently came home from a trip to Florida where he had stayed in multiple hotels. He takes occasional ibuprofen for knee pain, but denies taking other medications or having other health problems. He has no known drug allergies. The physical examination reveals a male with several tiny vesicles and scales in between the fingers, on the feet and ankles, around the patient’s wrist and around the belt line.

Primary Diagnosis: Scabies

Scabies is not an infection, but an infestation. Tiny mites called Sarcoptes scabiei set up shop in the outer layers of human skin. The skin does not take kindly to the invasion. As the mites burrow and lay eggs inside the skin, the infestation leads to relentless itching and an angry rash. When a person is infested with scabies for the first time, it can take four to six weeks for the skin to react. The most common symptoms are: Intense itching, especially at night, a pimple-like rash, scales or blisters, Sores caused by scratching. In its early stages, scabies may be mistaken for other skin conditions because the rash looks similar (Buttaro, et al., 2017). Scabies mites can live anywhere on the body, but some of their favorite spots varies by age include: Between the fingers, The folds of the wrist, soles of the feet, elbow or knee, around the waistline and navel, on the breasts or genitals, the head, neck, face, palms, and soles in very young children (Buttaro, et al., 2017).

Scabies typically spreads through prolonged, skin-to-skin contact that gives the mites time to crawl from one person to another. Shared personal items, such as bedding or towels, may occasionally be to blame. Scabies can be passed easily between family members or sexual partners. It is not likely to spread through a quick handshake or hug. The scabies mite can’t jump or fly, and it crawls very slowly (Buttaro, et al., 2017). Scabies typically spreads through prolonged, skin-to-skin contact that gives the mites time to crawl from one person to another. Shared personal items, such as bedding or towels, may occasionally be to blame. Scabies can be passed easily between family members or sexual partners. It is not likely to spread through a quick handshake or hug. The scabies mite can’t jump or fly, and it crawls very slowly (Buttaro, et al., 2017).

Diagnosis and Treatment

Scabies is diagnosed by visual examination. The doctor may also use a small needle to dislodge a mite or scrape the skin to look for mites, eggs, or fecal matter. Scabies will not go away on its own. It can only be cured with prescription medications that kill the mites. Treatment is a cream or lotion that is applied to the entire body from the neck down in most cases. It is left on for 8 to 14 hours and then washed off. Treatment takes up to three days, depending on the medication used (Buttaro, et al., 2017). While prescriptions can kill scabies mites and their eggs, they don’t provide any immediate itch relief. To control itching, especially at night, antihistamine pills can help.

Hydrocortisone cream may also help, but it can change the appearance of the scabies rash, making the condition harder to diagnose. It’s best to use this cream only after the doctor has confirmed the diagnosis. Scabies mites can live up to two to three days on the surface of clothes, bedding, or towels. To make sure these mites are killed, wash any sheets and clothing used by the affected person within the past three days. Wash the items in hot water and dry them in a hot dryer or take them to a dry-cleaner. Items that can’t be washed should be placed in a sealed plastic bag for at least one week (). In the case of the 46 years old man, he had recently come home from a trip to Florida where he had stayed in multiple hotels, because a scabies infestation is extremely contagious and mites can spread to clothing and bedding, he might have gotten it from the hotel beddings or towels or even the windows cotton.

Differential Diagnosis:

Bedbugs

Despite their role in an adorable bedtime proverb, bedbugs are pesky little pests. They sneak into your bed, your furniture, even your carpet, and while you sleep or watch TV, they bite you. The next morning, you’re left wondering why you’re red and itchy. Bedbugs are small, flat, oval-shaped insects. They do not have wings and rely on humans to carry them from one place to the next. Bedbugs are a reddish-brown color and can be between 1 and 7 millimeters (Doggett, et al., 2017). They feed on blood from humans or animals, and they’re most active at night, feeding on their victims while they sleep. Some people will not experience a reaction to a bedbug bite at all. Those that do experience symptoms of a bite are likely to experience one or more of the following: A bite with a red, swollen area and a dark red center, bites in a line or grouped together in a small area, blisters or hives at the bite site (Doggett, et al., 2017).

Bites can happen anywhere on the body. Most commonly they occur on areas of skin that are exposed while sleeping, such as the face, arms, legs, and hands. Bedbug bites are often very itchy. You may experience a burning sensation on the skin several days after you’ve been bitten. You won’t feel the bugs bite you because they excrete a tiny amount of anesthesia into your body before they bite (Doggett, et al.,2017). . If you scratch the bite, you may cause a secondary infection that can lead to swelling and bleeding. If you react to their bites, they may become slightly swollen with an itchy, irritating red center (Doggett, et al., 2017).. When this happens, they visually resemble mosquito or flea bites in their earliest stages. However, bedbug bites can appear in small groupings or in a straight line. Mosquito bites are more sporadic. Flea bites remain very small and are typically located on your legs or ankles (Bernardeschi, et al., 2013).

NURS 6531 Case Study 1

Bedbugs are most common in facilities that have a lot of people, a lot of turnover, and close quarters. However, they can also come into your home if brought there. Listed below are the places that most commonly have bedbugs: Hotels, hospitals, homeless shelters, military barracks, college dorms, apartment complexes, and business offices. Most common hiding sites for bedbugs are: Bed frame, headboard, mattress, box springs, pillows, bed skirts, in the crevices and seams of furniture, in carpeting at baseboards or under furniture, in curtains or other fabrics. Bedbugs like to hide where you sleep. If you find bites and suspect bedbugs, search around for them. You may not see the bugs themselves, but you might see tiny black dots (their droppings) or red smears, signs they’ve been biting you (Bernardeschi, et al., 2013). Again this 46 years old is at risk due to travelling from one hotel to another, and sleeping in different bed or chair which might have bedbugs hanging around waiting for him to rest on.

Diagnosis and Treatment

Bedbugs are more annoying than they are dangerous or deadly. The symptoms of a bite typically disappear in one to two weeks. Use an anti-itch cream to keep yourself from itching the bite. Take an antihistamine to help reduce the itching and burning (Bernardeschi, et al., 2013) . Ice packs can help numb the skin and reduce your urge to scratch. Use an antiseptic cream or lotion if you get an infection. If you find bedbugs in your home, call the landlord or pest control company to have your home treated (CDCP, 2016). Getting rid of bedbugs yourself is hard, and you may prolong infestation if you do not get professional treatment. Bedbugs can hide for several months without feeding, so getting a professional treatment can help you make sure you’re getting rid of the blood-sucking pests completely (Bernardeschi, et al., 2013).

Case Study: A 46-year-old male presents to the office complaining of a pruritic skin rash

Contact dermatitis

Dermatitis is used to refer to a class of various skin conditions with distinct characteristics. In some cases, the medical terms dermatitis and eczema may be interchangeable, but they do not always refer to the same condition. While all the different types of dermatitis cause what can be defined as a rash, the type of skin irregularities each type of dermatitis brings on is distinctive nonetheless (CDCP, 2016). There are two sub-types of contact dermatitis, which are allergic contact dermatitis and irritant contact dermatitis. Each type of contact dermatitis is caused by the skin getting in contact with a substance to which it is sensitive or reactive. In allergic contact dermatitis, a sensitive immune system reaction is the culprit (Emily, et al., 2019). In irritant contact dermatitis, on the other hand, the skin reacts to being in contact with a substance due to its chemical composition (such as a product containing harsh chemicals) or simply because of frequent, repeated exposure to a harmless element.

For instance, water can damage the outer layer of the skin on the hands due to over-washing. The most common symptom of allergic contact dermatitis is the formation of a red, itchy, and painful rash at the site of contact with an allergen. Oozing sores may also develop and become crusty over time. Similarly, irritant contact dermatitis also causes a red, itchy, and painful rash where the skin makes contact with a trigger substance. Patients may experience patches of dry skin that resemble burn marks (Joshua, et al., 2018).

Diagnosis and Treatment

Diagnosing a rash and its root cause begin with taking a thorough personal and family medical history, including symptoms and exposure to common allergens and infectious diseases, and completing a physical examination. If an allergy is suspected to be the cause of a rash, diagnostic testing may include skin patch testing. In a skin patch test, small amounts of common allergens are applied methodically to the skin to determine what substances are triggering an allergic response (Emily, et al., 2019) . A blood test called a radioallergosorbent test (RAST) may also be done to help identify the substances that are causing an allergy.

For suspected food allergies, a patient may also be asked to keep a log to record the types of foods that trigger an allergic reaction that includes a rash. Making a diagnosis also includes performing a variety of other tests to help to determine other potential underlying diseases, conditions or disorders, such as meningitis and other infectious diseases. Diagnosis may also include a complete blood count, a blood test which can help to determine if an infectious process is present. A lumbar puncture may be done if meningitis is suspected (Emily, et al., 2019).

Case Study: A 46-year-old male presents to the office complaining of a pruritic skin rash

Treatment for a rash due to an allergy or such causes as contact dermatitis or eczemaincludes a combination of treatments that include lifestyle changes with medications and other treatments as appropriate. This includes avoiding exposure to irritants and allergens and minimizing skin dryness. Typical skin irritants and allergens include soaps, chemicals, cleaning products, weeds, and some metals, such as nickel. Skin dryness can be avoided or treated by using a perfume-free moisturizer, avoiding scratchy clothes, and using a home humidifier (Joshua, et al., 2018). Other important steps include avoiding alcohol and caffeine, using mild soaps, not over washing or scrubbing skin, and avoiding hot tubs, steam baths, saunas and chlorinated swimming pools. Ice bags or cool wet compresses may be helpful to help relieve a rash. Therapy can also include taking an oatmeal bath and using oatmeal soap, such as Aveeno. More severe cases of a rash may be treated with a corticosteroid cream, which reduces inflammation and an antihistamine, which reduces a rash. These medications can have side effects, so they should only be taken under the direction of a licensed health care clinician (Joshua, et al., 2018).

References

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.

Bernardeschi, C., LeCleach, L., Delaunay, P., and Chosidow, O. (2013). Bed bug infestation. BMJ. 2013; 346 https://doi.org/10.1136/bmj.f138

Doggett, S.L., Dwyer, D.E., Penas, P.F., and Russell, R.C.  (2017). Bed bugs: clinical relevance and control options. Clin Microbiol Rev. 2012; 25: 164–192 https://doi.org/10.1128/cmr.05015-11

Emily C. Milam, Sharon E. Jacob and David E. Cohen (2019). Contact Dermatitis in the Patient with  Atopic Dermatitis, The Journal of Allergy and Clinical Immunology: In Practice,         10.1016/j.jaip.2018.11.003, 7, 1, (18-26), (2019).

Joshua L. Owen, Paras P. Vakharia and Jonathan I. Silverberg (2018)., The Role and Diagnosis

of  Allergic Contact Dermatitis in Patients with Atopic Dermatitis, American Journal of Clinical Dermatology, 10.1007/s40257-017-0340-7, (2018).

US Centers for Disease Control and Prevention (2016). Parasites—bed bugs. 2016.            . Accessed February 12, 2017

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