Annie Chambers iHuman
Key Findings
Bilateral inner thighs with 10 x 12 cm raised, confluent, erythematous papules and blisters in various stages
Left ventral forearm with 6 cm linear, erythematous papules, and yellow-red blisters
Itching progressing to tenderness
New exposures: Wild brush plants, insects
New exposures: Hot tub
New exposures: Oily suntan lotion
New exposure: Scallops
PMH: No change since last visit
Additional SH: No relevant change in tobacco, alcohol, drug use, lifestyle
Medications/Allergies: No change, hives to cefaclor
ROS: No constitutional, cardiorespiratory, or gastrointestinal symptoms
Communication: Effect on the patient’s life
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Annie Chambers Human Problem Statement
The patient, a 25-year-old otherwise healthy female, presents with 2 days of intensely pruritic erythematous papular rash on the inner thighs and left inny forearm. Recent exposures include hiking through the woods, hot tub use, new lotion use, and ingesting scallops for the first time in her life. Physical examination shows a 6 cm set of linear, circumscribed, erythematous blisters on the left inner forearm and a 10 x 12 cm scattered contiguous erythematous papular rash with surrounding superficial excoriations on the inner thighs. Vitals and the remaining physical examination are unremarkable
Annie Chambers Human Management Plan
Pharmacologic Care:
- Apply clobetasol propionate 0.05% cream twice a day until clear.
- Take OTC cetirizine 10 mg 1 tab PO daily as needed for itching.
Supportive Care:
- Take oatmeal baths.
- Apply cool, wet compresses to affected areas.
- Apply topical calamine lotion or aluminum acetate to affected areas.
Patient Education:
- Educated patient on the diagnosis of contact dermatitis, potential etiologies, treatment regimen, and prognosis.
- Advised the patient to avoid poison ivy, oak, and sumac. Explained plant appearance.
- Educated patient on medications, including indications, proper administration, side effects, and red flag symptoms for discontinuation.
- Advised patient to wash all clothing, towels, sheets, etc., in hot water to remove potentially irritant oils.
Follow-Up:
- Follow up in the clinic if symptoms do not start to improve within 48-72 hours.
- Discussed warning signs to call the clinic immediately or to go to the ER, including but not limited to difficulty breathing, increased swelling, vomiting, fever, purulent skin discharge, or other concerning symptoms. Annie Chambers iHuman
