Non-Healing Skin Lesion Case Study

1290 WordsAug 31, 20176 Pages
Non-healing Skin Lesion With a plethora of skin lesion etiologies, a thorough focused history and physical examination is essential for recognition and its diagnosis (Dains et al., 2016, p. 325). In the case of John and his children, the onset of the lesion as well as his exposure to the outdoors are considered in the differential diagnoses. Additionally, both the positives and the negatives were taken into consideration when noting his history, in the review of systems, and in the physical examination. For example, some of the notable positives are: 1) the presence of a unilateral, purulent, and erythematous round lesion that is warm to touch; 2) the exposure to the outdoors with hobbies including camping, biking, and Nordic skiing; and…show more content…
337). Additionally, lesions can be pale, erythematous, and macular with fine scaling; but can also present as papular or vesicular (Ball et al., 2015, p. 147). Moreover, the “herald patch” precedes a few days to 3 weeks before generalized eruption of truncal and/or extremity lesions occur (Dains et al., 2016, p. 340). Furthermore, the lack of response with over-the-counter topical antibiotics might be due to the lesions’ possible viral etiology. Therefore, pityriasis rosea is highly considered as the primary diagnosis for John’s non-healing skin lesions. What is the Secondary Diagnosis? Due to the absence of systemic manifestations (i.e. fever, arthralgia, lymphadenopathy) and considering the possible life-threatening consequences of its disease-process, the secondary diagnosis for John is early onset Lyme disease. Given that it is also the most common vector-borne disease in the United States, with over 300,000 new cases reported to the Centers for Disease Control and Prevention (CDC) each year, this diagnosis was taken into consideration (Crowder et al., 2014, p. 784). Additionally, the rash can appear on any area of the body and occurs in approximately 70% to 80% of infected individuals (CDC, 2016). Moreover, an early sign of Lyme disease seen in John is an erythematous rash (erythema migrans), which may feel warm to touch but is rarely itchy and painful (CDC, 2016). What Diagnostics are Needed? There are no non-invasive tests that can confirm the
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