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NURS 6531 WEEK 2 IHUMAN 4 DIFFERENTIAL DIAGNOSIS
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NURS 6531 WEEK 2 IHUMAN 4 DIFFERENTIAL DIAGNOSIS
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lOMoAR cPSD| 22896205NURS 6531 WEEK 2 IHUMAN 4
DIFFERENTIAL DIAGNOSIS-
Contact Dermatitis- (Primary Diagnosis)
Contact dermatitis is a common inflammatory skin condition caused by repetitive skin contact
with allergens or irritants, resulting in allergic or irritant contact dermatitis. The common signs
and symptoms of dermatitis are pruritus, burning, and stinging. Allergic contact dermatitis
commonly presents acutely with erythematous, induration papules and plaques, vesiculation,
edema, and bullae formation in severe cases. The rash is typically well-defined,
exposuredependent, and commonly involves the hands, face, and eyelids (Owen et al., 2018). In
the given case scenario, the patient reported that she went hiking and wore shorts and a tank top.
So, it is possible that her inner thighs and upper arm got exposed to some plant or other allergen
that caused her symptoms. The patient’s rash is raised and confluent, with erythematous papules
and blisters, similar to the rash of contact dermatitis. So, my primary diagnosis will be contact
dermatitis/ allergic contact dermatitis.
Folliculitis
Folliculitis is a benign skin condition that involves infection of the hair follicle. The hair follicle
becomes infected, which leads to inflammation and the formation of pustules or papules of the
overlying skin that covers the hair. It is commonly caused by Pseudomonas aeruginosa infection
from hot tubs and swimming pools when the skin is occluded by swimwear. Within 48 hours of
exposure, it presents with itching and pruritic papules or papulopustules ranging from two to ten
millimeters in diameter (Jacob & Tschen, 2020). The patient in the given case scenario has an
itchy, red, and bumpy rash with yellow-red blisters on her left forearm. The yellow-red blisters
indicate pus-filled blisters which is a common finding in folliculitis; therefore, my second
6531 WEEK 2 IHUMAN |
, lOMoAR cPSD| 22896205
differential diagnosis will be folliculitis. However, hot tub rash cannot be present only on the
inner thighs and upper arm. It should have been on all the surfaces immersed in the hot tub.
Hence it is not the primary diagnosis.
Acute Urticaria
Acute urticaria is a heterogeneous inflammatory skin disorder that causes disease-defining signs
and symptoms, itchy wheals (hives), and angioedema. The erythematous and edematous
urticarial plaques generally cover skin and mucous membranes. The acute urticaria can occur
due to the ingestion of a new drug, food that a person is allergic to, or a bug/insect bite. It is not
uncommon to have allergic reactions to seafood but clinically, half of the patients present with
only cutaneous wheals, 10% with angioedema, and 40% with both, an individual lesion last for
less than 24 hours (Jaros et al., 2019). The patient ate scallops for the first time in her life; she
may have acute urticaria due to a new food. It could also be due to a bug bite, as the
hypersensitivity reaction of a mosquito bite can be manifested through wheals, vesicles, blisters,
or scabs (Halpert et al., 2017). However, her rash does not appear as itchy wheals or clinically
similar to urticaria, as there is no mucous membrane involvement, and it's progressively
worsening. Therefore, acute urticaria will be my third differential diagnosis.
Impetigo
Impetigo is a bacterial infection of superficial layers of skin caused by gram-positive bacteria
and is highly contagious. The rash can be itchy and painful and presents as erythematous plaques
with yellow crust. The lesions generally occur in warm, humid conditions, and risk factors
include poor personal hygiene, lack of proper hand washing, crowding, diabetes, and other
medical comorbidities. It quickly spreads through shared towels, bed linens, and clothing. The
patient has erythematous papules and yellow-red blisters on the forearm, but the evolution of the
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