Dermographism: Concomitant Thyroid Disease

The patient was referred for a new itchy and tender bilateral groin lesions that the patient says will drain pus. He also has multiple other complaints. He gives a history of being allergic to DOXYCYCLINE. As previously stated, he has tender sites which can drain pus off and on in his groin for years. There is also history of facial acne and scalp acne since his late teens. He took Accutane during his 20s with improvement by history. He flared and repeated Accutane about one year after completing the first course by his history. He is bathing with unscented Dove and uses cocoa butter lotion. He also has a second problem of itching over his back, shoulders, and arms, and legs

Skin (history of skin disease, pigment or color change, change in mole, excessive dryness or moisture, pruritus, excessive bruising, rash

The skin disorders that might results from hereditary, congenital, or acquired pathological processes are ichthyosis, bullous diseases, chronic infections of the skin, dermatitis, hiradenitis suppurativa, genetic photosensitivity disorders, and burns.

Mr. Jackson presents for above concerns. He was seen initially on 12/19/2016 for evaluation of facial irritation by nursing staff. He states he had been using a straight razor daily and had significant skin irritation along his neck, had been instructed to use warm compresses along with Calmoseptine and was instructed to not shave for three days and follow up thereafter. Skin lesions worsened and although he was instructed to shave on Monday, Wednesday, and Friday for a shaving profile. He was instructed to not shave his face until seen today. Additionally, he has had dry skin on his hands primarily with some cracking along the knuckles of the right hand. States he has been working at KP and has his hands in water for a good portion of the day. He had been using some hydrocortisone cream and has seen some improvement.

L.F, age 91, diagnosed with hypertension, dementia, and hx of falls. The clients general skin pigmentation had no deviations or abnormals from normal skin color, expect for on the clients left buttock. The area on the buttock was red, but still blanchable. The skin was warm to palpate in all areas of body expect for her hands. The clients hands were cold to touch but no problems or complaints noted from the patient. Skin turgor tested on clients sternum and top of hand. Skin turgor was loose and returned to normal baseline within one second. The clients skin was soft to touch, with only small area of dryness located on the clients buttock. Client had many winkles all over body. There was no odor detected on client. Deodorant was used during

Eczema is a skin disorder which some people are born with eczema.Eczema is a skin disorder which some of the symptoms are dry skin, red patches in the skin, itching and painful nights of no sleep because of the itchings. There's no cure for eczema but there is treatment such as bathing, over the counter medication and using bleach, vinegar, oatmeal or evening using baking soda when taking a bath. It helpful to moisture after bathing or showering, by keeping the skin moisture it help the symptoms be calm and reduce the itching , redness and the dyers of skin.

Keratosis pilaris (KP) is also referred to as follicular keratosis. This skin condition is characterized by the formation of small, rough bumps on the surface of the skin (similar to goosebumps). Due to its appearance and rough texture, KP is frequently referred to as ‘chicken skin.’ This condition affects approximately 40 percent of adults and up to 80 percent of adolescents. While follicular keratosis is considered harmless, it can be bothersome because it is unsightly and usually leaves the skin feeling dry, and itchy.

Dermatitis is a general term that describes an inflammation of the skin. There are different types of dermatitis, including seborrheic dermatitis and atopic dermatitis (eczema). Although the disorder can have many causes and occur in many forms, it usually involves swollen, reddened and itchy skin. (www.umm.edu/altmed/articles/dermatitis-000048.htm)

Diagnosis can be made by observation based on the appearance of honey-colored scabs found in the usual areas of the arms, legs and face. If visual diagnosis cannot be made a culture test for resistant bacteria can be done.

Clinical manifestations include fever, myalgia, rash, papules, macules that lead to sloughing and eventually necrosis, the skin can look like a scalding burn, mucosititis, and respiratory distress from interstitial edema, gastrointestinal issues ranging from diarrhea to ulceration and bleeding, ocular issues such as conjunctivitis to inflammation, photophobia up to and including loss of vision (Cooper, 2012). Any body system that has epithelial tissue can be subsequently affected. The further the condition progresses the higher the degree of mortality. Being alert to the possibility of the condition and trying to get as much information from the patient regarding medication usage, to include over the counter and herbal is vital because time is critical factor (Cooper, 2012). Misdiagnosis

Atopy is defined as an inherited tendency to produce immunoglobulin E antibodies in response to common environmental proteins such as pollen, house dust mites, and food allergens. Atopic dermatitis affects about one-fifth of all individuals during their lifetime, but the prevalence varies throughout the world. Around 50 percent of patients with atopic dermatitis will develop symptoms within their first year of life, and probably 95 percent experience an onset below five years of age. A child with moderate to severe atopic dermatitis have 50 percent of risk of developing asthma and 75 percent of risk of developing hay fever. A typical patient with atopic dermatitis will present with an early onset of itchy eczema localized at sites such as the flexures of the elbows and knees. The skin lesion in atopic dermatitis is not differ from other eczemas such as contact eczema. In its acute form, eczema is characterized by a lively red infiltrate with edema, vesicles, oozing, and crusting. Whereas in the subacute and chronic form, lichenification, excoriations, papules, and nodules are noted (Thomsen,

We should also look for any atypical skin lesions. Lesions with purpuric, non-blanchable, and which is palpable are characteristic of urticarial vacuities. These lesions may or may not leave some residual pigmented changes. Hives, which are of tiny pinpoint, are characteristic of cholinergic urticaria (46). Can observe the edema by slightly stretching the skin to demonstrate whitish centers. Occasionally some larger annular urticarial lesions, which can be as large as 30 cm in diameter, can be observed with polycystic borders.

According to Merck Manual Professional Edition (n.d), contact dermatitis is a condition of skin becoming red and sore after contacting with allergens substances. The clinical manifestations that the 27 years old is showing contact dermatitis. Contact dermatitis is cell mediated hypersensitivity allergic reaction by Langerhans (dendrites epidermal cells), which then the cells migrate to reginal lymph nodes where they present the antigen to T cells. T cells then release cytokines and activate inflammatory cells. (Huether & McCance,

The patient is a 69-year-old female who tells me she went swimming this past Monday. She did change out of her bathing suit quickly. She tells me last night however, she was having some itching in her groin. She noticed that there was a rash there. She did put some Desitin on it last night. It continues to be pruritic this morning. She has tried a barrier powder today. She has not had a rash like this before. She is otherwise feeling well. She does have a history of prediabetes.

An 18-year-old male presents to the clinic complaining of skin changes over his arms and legs that have been persistently reappearing for the past few months. He says they are “unbearably itchy” and usually appear when he is outdoors, sweating a lot, or after he bathes. He claims that he wants some definitive treatment for them as they interfere with his academic activities. He uses generic lotion frequently because he tends to have dry skin, but the lotions have been ineffective with these itchy rashes. In review of activities, the patient explains that he has just returned from a biking and hiking trip in the mountains with friends, and recalls only one event where he fell in some bushes. Otherwise he admits to “staying clean” throughout his trip and bathing twice a day. The review of systems, in addition to his skin complaints, is otherwise negative. His past medical history includes mild persistent asthma and allergic rhinitis. His medications include an albuterol inhaler as needed,