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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Assess the signs and symptoms of common skin disorders in a presenting patient

  • List the goals of treatment for patients with common skin disorders

  • Select appropriate nonpharmacologic and pharmacologic treatment regimens to patients presenting with common skin disorders

  • Identify the adverse effects that may result from pharmacologic agents used in the treatment of common skin disorders

  • Develop a monitoring plan that will assess the safety and efficacy of the overall disease management of common skin disorders

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PATIENT PRESENTATION

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Chief Complaint

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"This rash seems to be getting worse and it itches so bad that I cannot sleep at night."

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History of Present Illness

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Emily Evan is a 17-year-old female who presents to the dermatologist complaining of a rash on her hands and face that is getting worse. In these areas, the rash appears as pruritic, thickened plaques. A similar rash has recently appeared in the folds of her arms and legs; however, these pruritic areas also include erythematous papules and vesicles. A family friend who is a nurse recommended a nonprescription topical cortico steroid (hydrocortisone). The patient recalls having a similar rash as a child that responded to the hydrocortisone, so she has tried it sporadically over the last several months. In addition, in her childhood, she suffered food allergies to peanuts, eggs, and milk, but eventually outgrew this allergy and can tolerate these foods now. The rash, however, seems to come and go with the seasons and her stress level. She is currently having trouble in school and with her boyfriend; she is also trying to find a college despite her lack of funds and poor grades. She frequently wears tight-fitting clothes, makeup, and perfume.

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Past Medical History

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Food allergies to peanuts, eggs, and milk as a young child, now resolved.

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Allergic rhinitis since age 6

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Family History

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Both parents are alive. Father currently has asthma and mother has a history of allergic rhinitis. She has two younger sisters, one of which has asthma.

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Social/Work History

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Currently, she is a "C" student in high school and is not involved in extracurricular activities. She claims to have a boyfriend in college who likes to "spend a lot of time with her." She was employed part-time at a local fast-food restaurant but quit due to decreasing grades and to spend more time with her boyfriend.

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Tobacco/Alcohol/Substance Abuse

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Denies any routine use, but does admit to occasional alcohol use when around her friends. Admits her boyfriend smokes constantly.

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Allergies/Intolerances/Adverse Drug Events

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None known at this time; seems to tolerate peanuts, eggs, and milk, but seldom eats them due to her childhood allergy

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Medications ...

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