Assignment: MEDICAL MYSTERY
DERMATOLOGY ASSOCIATES
Name: John C.
Age: 27
Height: 5' 7"
Weight: 165 pounds
Symptoms: rash, itch, joint pain
HIS STORY
John was an operating room nurse. One day, he observed a skin rash on his elbow. The rash was itchy, but he initially thought nothing about it. He applied some moisturizing cream, but 2 weeks later, he noticed the rash was still present and appeared to be getting worse. When he looked at his elbow in a mirror, he noticed that there was a large reddish patch on the surface of the elbow, and the rash appeared to have some fine scales on it. He now thought he had perhaps acquired an infection from a patient, and he decided to see his doctor.
John's family practitioner prescribed him some Polysporin and told him it was probably just eczema. The rash persisted, and John noticed that the skin had thickened and was turning silver-gray. He started to feel some pain in the elbow joint but did not know if this was real or imaginary. He asked several other health care professionals at work, and they all told him that he probably had contact dermatitis and it would get better. John continued to apply all types of creams and lotions on the skin, but things only became worse. John finally asked for a referral to a dermatologist.
THE EVALUATION
When I examined John in our dermatology clinic, I suspected that he had one of two skin disorders: eczema or psoriasis. I asked John about his past history, drug use, family history, and history of allergies. All of these were unremarkable except that John's uncle had a similar skin problem on his knees years ago. That was the clue I was looking for.
THE DIAGNOSIS
John had the classic signs of psoriasis. His rash was in a typical place, on the elbow, and the rash had developed into a patch with silvery scales. These findings are seen in the majority of individuals with psoriasis. John was worried that it might limit his career. I told him that the condition was treatable, but that he would get flare-ups every now and then. John wanted to know if I was certain about the diagnosis and asked about blood tests. I explained to him that the diagnosis of psoriasis is largely based on the patient history and clinical features.
THE TREATMENT
Because John's psoriasis was mild, I decided to treat him with topical medications. I told him to apply an ointment that is a vitamin A derivative, or topical retinoid, and that he should keep his skin clean and dry. In addition, I told him to avoid any sun exposure while he was applying the retinoid as these drugs can make the skin extra sensitive to the sun.
CASE CLOSED
Psoriasis is a common skin disease that affects the life cycle of skin cells. As a result, cells build up rapidly, forming thick, silvery scales and itchy, dry, red patches that are sometimes painful. When John returned for his follow-up appointment, the red patch on his elbow had disappeared and the rash was nonexistent. I asked him to read up on psoriasis so that he would understand why he should avoid stress and alcohol. I warned John that this condition could flare up anytime, and that he will probably have to deal with it for the rest of his life. I also mentioned to John that he might have some early symptoms of psoriatic arthritis, which can cause pain, stiffness, and swelling in and around the joints.
Discussion Questions
• What is psoriasis?
• The lesions of psoriasis are referred to as plaques. Define pLAque as used to describe a skin lesion.
• At first, the doctor thought John might have eczema. Describe this condition. What is the difference between eczema and psoriasis?
• Some of his coworkers suggested that John might have developed contact dermatitis. How would you define this condition? What are some causes of contact dermatitis? How is it different from exfoliative dermatitis?
Format your assignment according to the following formatting requirements:
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