PRAC 6541 Episodic Visit: Dermatology Focused Note

Case Study: Dermatitis

Subjective:

Chief complaint/s: febrile seizure, rashes all over body after seizure, itchy, mainly on lower backHPI: 6/12/24 A.Z is a 22mos old male who presents to the hospital for follow-up. However, he reported symptoms of a skin rash, which started in the morning. He also reports a relapsing fever, and his eyes are rolled. Brought to emergency and was advised to give Tylenol and ibuprofen 6.5mL q6 PRN for fever. The scattered papules spread on extremities. They involve the trunk: macular eruption, flat, and scaling. Spread from the initial area. His skin rashes have been present since Monday. Not pruritic. Not responsive to OTC HC cream. Current Medications:

Past medical History

Allergies: Pollen per mother

Medication: The patient has been on a long course of Mortin and Tylenol medications.

Birth history: The child was born at term under expected SVD delivery and weighed 2600g. the child had complications at birth and was alive and well.

Review of systems:

Constitutional: The patient has a positive fever, chills, or malaise

Skin: The patient has itching skin, rash, and color changes. The patient has no nail deformities or brittle nails.

Head: The patient has dull headaches with no dizziness and syncope.

Eyes: no  diplopia, abnormal discharge, tearing, and double vision.

Ears/Nose/Throat: n/a

Respiratory: Tno wheezing or shortness of breathe

Cardiovascular: n/a

Gastrointestinal: per parents no diarrhea or constipation

Genitourinary: diaper change 6-8/days

Musculoskeletal: n/a

Neurological: The informant denies the patient’s history of numbness, tingling, tremors, weakness, convulsions, and changes in speech.

Psychiatric: n/a

Objective:

Vital Signs: Weight: 30 lbs height 2’ 5’ Temperature: 96.70 F Vital signs: B.P.: 103/62 mmHg PR: 99 bpm R.R.: 24 per minute, Oxygen saturation: 95%.

Physical Examination:

General appearance: The patient is well-nourished, alert, responsive, and has no apparent physical distress. No lymphadenopathy, pallor, jaundice, dehydration, cyanosis, or edema.

Skin: Warm and good turgor. Has multiple lesions, nodules, and scattered rashes all over the body. No onychomycosis. The skin is hyper-pigmented and has an erythematous lesion that is scattered.

HEENT: The head is Normocephalic and atraumatic—no scleral icterus. Pupils are equal, round, and reactive to light and accommodation; mild conjunctival injection. The oropharynx is clear. Mouth revealed good dentition, no lesions. Tympanic membranes are transparent.

Chest/Lungs: normal breath sounds bilateral, expiratory phase, and no wheezing. There is normal vocal resonance and tactile fremitus.

Cardiovascular: The patient has a regular heart rhythm and no murmurs or gallops.

Abdomen: The abdomen is symmetrical with no obvious distension, non-tender, and no hepatosplenomegaly.

Musculoskeletal: N/a

Neurological: the patient has no apparent neurological deficits. Cranial nerves, motor strength, sensory exam, and reflexes are normal. All cerebella activity is intact, and fine control of movements is intact.

Psychiatric: n/a

Diagnostic Test

CBC: for WBC count.

Liver function test

Kidney function test

Assessment:

Papular Dermatitis: Papular dermatitis is an allergic or inflammatory skin disease that manifests in small, even raised bumps with a shiny surface. These bumps are painful, itchy, and inflamed or red. The allergic cause may indicate that food substances, drugs, pollens, and animal dander may cause dermatitis. It should be noted that inflammatory causes may be related to any insect bite or eczema reaction (Bhuiyan, 2021). Treatment measures used in this condition include stressing allergen prevention, administration of topical corticosteroids, and application of emollients.

 Maculopapular dermatitis is a skin disease marked with skin changes: macules, flat discolored lesions, and papules, small raised lesions. It is claimed that a rash of this type can be associated with viruses or bacterial infections. The causes are viruses, for example, measles, rubella, and enteroviruses (Parodi et al., 2020). The patient presents with fever, general weakness, and rash on the skin all over the body. The standard treatment is on the condition contributing to the rash, comfort care, and not exposing the patient to substances that may cause worsening of the rash.

Roseola Fever: Roseola is a disease that affects very young children and is caused by a human herpesvirus 6 (HHV-6). The illness usually begins with a short period of high fever, primarily for 3 to 5 days, then after the temperature decreases, the child will develop a rash. The rash involves pink macules and papules that involve the trunk and progress to the limbs (Engel et al., 2020). Though it is often not a serious health issue and will resolve on its own, the therapy for the condition is usually reduced with the help of drugs like acetaminophen and ibuprofen or by ensuring the child’s proper hydration.

Management/plan

I would continue with the current medication to control the symptoms. However, I would increase the dose frequency to QID to ensure faster and more effective recovery. I would add into the current medicines sedating anti-histamines such as chlorpheniramine taken orally TIDs. Secondly, I suggest adding prednisolone ointment to the topical medication to combat the inflammatory effects of the rashes and blemishes. Finally, I would administer analgesics such as acetaminophen to combat the inflammatory response of the rashes and fever. I would also administer emollients to help keep the skin supple and soft (Patil).

Patient Education:

I will educate the parents on the possible risk factors/allergens of the patient’s skin disease development and potential ways to curb the disease. I would also inform the parents on how to administer medication to help achieve maximum child care and outcomes.

Follow-up:

I will book the patient for a two-week follow-up schedule on skin medication response and follow-up on drug side effects.

Reflection

The most common dermatological condition among children is allergic in nature. Papular dermatitis and Maculopapular dermatitis are some common allergic pediatric dermatological conditions. Secondly, because of low immunity among children, less virulent viruses may also cause dermatological conditions like Roseola fever (Bhuiyan, 2021)—treatment of dermatological conditions aims to eliminate the causative agents and symptoms to restore good skin health. Anti-allergies, anti-inflammatories, and emollients are the primary drugs for proper patient outcomes. The primary approach to controlling dermatological disease among pediatric patients involves preventive measures and parents’ education on avoiding causative agents and allergens. Young age, untidy environments, low socioeconomic status, poor primary health services, and poor nutrition and education are the leading predisposing factors to pediatric dermatological conditions (Parodi et al., 2020).

References

Bhuiyan, M. S. I. (2021). Dermatological emergency and life-threatening skin conditions.

Engel, L. S., Sanders, C. V., & Lopez, F. A. (2020). Diagnostic Approach to Rash and Fever in the Critical Care Unit. In Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine (pp. 109-133). CRC Press.

Parodi, M., Ciccarese, G., Drago, F., Cozzani, E., Buligan, C., Turina, M., & Parodi, A. (2020). Annular and arciform lesions of the palms are unique manifestations of secondary syphilis. International Journal of STD & AIDS, 31(13), 1323-1326.

Patil, P. Causes of Fever in Healthcare Professionals. Dr. Jagdish Chinnappa, 14.