Visit Date: 1/09/2019
Patient: Mr. S
Informant: Pt himself, reliable.
CC: “irritating rash” x1 week
HPI:39 y/o male presenting to clinic /c no significant PMH, c/o rash on body x 1 week. Patient developed rash 7 days ago after day at construction site. Patients states rash started on legs and spread up to stomach and arms. Admits severe itching that is worse at night. He has never had a rash like this before. Pt applied Cortisone 10 with minimal relief. He denies fevers, chills, SOB, chest pain, myalgia, arthralgias, abdominal pain, n/v/d or urinary symptoms. He denies recent travel, toxic chemical exposures, medication changes, numbness, tingling or sick contacts
PSH: Appendectomy 2016
- Up to date
- Flu shot 2018
- Mother: Alive 70s, Diabetes
- Father: Alive 80s, CAD
- Caffeine/coffee x4 a day
- Denies drugs, smoking/tobacco/illicit drug use
- Alcohol: socially, 1-2 drinks per week
- Marital Status: Married, Sexually active with wife, use protection
- Exercise/Diet: Works out x5 a week, eats x4 meals a day
- Occupation: Construction Worker
General: Denies fever, night sweats, chills fatigue, weakness
Skin, hair, nails: SEE HPI
Head:Denies h/a, vertigo, lightheadedness
Eyes:Denies glasses, blurring or recent visual disturbances
Ears:Denies hearing loss, pain, discharge and tinnitus,
Noses/sinuses:Denies discharge, epistaxis, obstruction
Mouth/throat:Denies bleeding gums, sore tongue, sore throat, mouth ulcers
Neck:Denies localized swelling/lumps, stiffness or decreased ROM
Breast:Denies lumps, nipple discharge, pain
Cardiac: Denies murmurs, palpitations, DOE, orthopnea, CP
Respiratory: Denies dyspnea, SOB, cough, wheezing, hemoptysis, cyanosis, PND
GI: No appetite changes. Regular BMs. No blood in stool .
GU: Denies urgency, dysuria, changes in frequency, hesitancy, dribbling
MSK: Denies arthralgias, swelling, joint pain or back pain
Peripheral Vascular: Denies claudication, trophic changes, peripheral edema
Heme: Denies anemia, easy bruising or bleeding, lymph node enlargement
Endo: Denies polyuria, polydipsia, polyphagia, heat/cold intolerance, goiter, hirsutism
Nervous: Denies seizures, tingling/numbness, sensation changes.
Psych: Denies little interest or pleasure in doings things. No feelings of depression or hopelessness
General Appearance: Alert and oriented. Appears documented age. Small build. Good hygiene and grooming. Posture, gait not assessed. Patient in no acute distress.
Temp: 97.8 F
HR: 70 bpm, RRR
BP: sitting 131/79 Right arm
BMI: 20.67 kg/m^2
RR: 17 breaths per min, unlabored
O2 Sat: 98
Pain Scale 0
Skin: Extensive widespread erythematous, papular rash and some vesicular lesions with some whitish yellow covering abdomen, upper extremities,lower extremities, between web spaces of fingers and toes. Lesions measure 2mm by 2mm.
Hair: Average quantity and distribution
Nails: cap refill <2 secs. No clubbing present
Head: normocephalic, atraumatic, Non tender to palpation
Eyes: Not assessed
Ears: Not assessed
Nose: Not assessed
Sinuses: Not assessed
Throat: Not assessed
Heart: RRR, Normal S1, S2. No murmurs heard. PMI in 5th ICS midclavicular No heaves, thrills noted
Lungs: Clear to percussion and auscultation bilaterally. No crackles, rhonchi, rales. No use of accessory muscles noted. Non tender to palpation bilaterally. Negative increase in tactile fremitus throughout.
Breasts: Not assessed
Abdomen: Symmetrical, ND/NT. BS present in all 4 quadrants. No bruits. Tympany to percussion throughout. Non tender to palpation. Neg CVAT bilaterally. No erythema, discharge or foul smell.
GU: Not assessed
Rectal: Not assessed
Peripheral Vascular: Pulses normal, no cyanosis no edema.
MSK: Not assessed
Neuro: Not assessed
- Contact Dermatitis/Seborrheic
- +Itching, inflammation
- Usually resolves 7-10 days
- –scaly patches, red skin on sides of nose, face etc
- +papular lesions
- +pruiritic rash
- +red bumps and yellow blisters on skin, widespread, crusted rash
- +itchy and painful
- –red, bumpy patches
- –covered in silvery scales
Assessment & Plan
39 y/o M presenting to clinic c/o of rash x 7 days that begin on lower extremeties and spread to upper extremeties. Extensive widespread erythematous, papular rash and some vesicular lesions with some whitish yellow covering abdomen, upper extremities,lower extremities, between web spaces of fingers and toes. Lesions measure 2mm by 2mm. Pt admits to severe pruritus which worsens at night. Pt clinical findings most consistent with scabies.
- Permethrin Cream- Apply overnight to all areas of body. Including face and scalp
- Benadryl 25-50mg, PO, q4-6 hours PRN for pruritus
Scabies is contagious, it is spread by direct skin to skin contact with person infested with scabies, typically4-6-week incubation period with primary exposure, 1-3 days for 2ndary exposure. Take precaution can spread/acquired sexually, avoid contact with others, avoid itching. Family members/spouses should be evaluated. Linens/clothes should be washed in hot water. Return to clinic if symptoms worsen.