Dermatology Differential Diagnosis

SAMPLE EXCERPT:

, 2014). Smoking and excessive alcohol consumption is also typically considered as risk factors. Vitamin D deficiencies are also known to be related to the condition. This is one of the newest established risk factors. Here, the research suggests that "a case-control study that compared 43 patients with psoriasis and 43 matched controls with other non-photosensitive dermatologic diseases found that serum levels of 25-hydroxyvitamin D were significantly lower in the patients with psoriasis even after adjusting for factors such as Fitzpatrick skin phototype (table 1) and estimated sun exposure" (Feldman et al., 2014). Finally, certain drugs can worsen psoriasis symptoms. Bacterial and viral infections may also increase risk.

Self-Treatment Methods

For most patients with psoriasis, home treatments are preferred. Thus, outpatient treatment options are most common. According to the research, "an alternative to office-based phototherapy is the use of a home ultraviolet B (UVB) phototherapy unit prescribed by the treating clinician. This option may be preferred by patients who are not in close proximity to an office-based phototherapy center, whose schedules do not permit frequent office visits, or for whom the costs of in-office treatment exceed those of a home phototherapy unit" (Feldman et al., 2013). This may seem a bit excessive, but for long-term sufferers, it can help make life much easier.

Pharmaceutical Preparations

There are also a number of treatments associated with physicians as well. Essentially, "treatment modalities are chosen on the basis of disease severity, relevant comorbidities, patient preference (including cost and convenience), efficacy, and evaluation of individual patient response" (Feldman et al., 2013). There are over the counter methods like corticosteroid creams. Prescription NSAIDs are also commonly used to treat the condition (Dunphy et al., 2011). Additionally, "topical therapy may provide symptomatic relief, minimize required doses of systemic medications, and may even be psychologically cathartic for some patients" (Feldman et al., 2013). Topical corticosteroid creams and anthralin and other tars are also commonly used (Feldman et al., 2013). Physicians may insist on oocclusion therapy, where the skin is wrapped up after the topical creams are applied so that they can better soak into the deeper layers of the skin (Feldman et al., 2013). Ultra violet light therapies can also provide relief. Systemic methods are often only use din the most severe cases. Thus, "severe psoriasis requires phototherapy or systemic therapies such as retinoids, methotrexate, cyclosporine, or biologic immune modifying agents. Biologic agents used in the treatment of psoriasis include the anti-TNF agents adalimumab, etanercept, and infliximab and the anti-IL-12/23antibody ustekinumab. Improvement usually occurs within weeks" (Feldman et al., 2013).

Health Promotion and Prevention Strategies

Health education is key to identify risk factors in patients' lives. Stress reduction is one of the key elements to help manage outbreaks. Also, Vitamin D supplements are useful for long-term prevention methods. It is important to stress patient education about changing lifestyle choices to reduce to risk of triggers (Dunphy et al., 2011).

Contact Dermatitis

Symptom Evaluation

This condition is a rash resulting from contact with some form of allergen or irritant. Essentially, "the cardinal symptom of contact dermatitis is a pruritic erythematous rash" (Dunphy et al., 2011). This rash often comes on quite quickly after the stimulus is introduced to the skin, with inflammation occurring within 6 to 12 hours of exposure. There are clear formation of papules and scaling skin as well as "clear fluid vesicles or bullae" (Dunphy et al., 2011). This matches with the patient's rash within this current case study. Skin reactions to environmental allergens and substances typically include reactions to antihistamines, anesthetics, hair dyes, latex, and other elements. Also naturally occurring elements like pollen, ragweed, and pet dander can cause condition symptoms.

Those with higher levels of allergens are most vulnerable. Still, "contact dermatitis accounts for 4 to 7% of all dermatology consultants" (Dunphy et al., 2011). White Americans seem to be the most vulnerable population. Moreover, females have higher rates over males, which make this a lesser chance for the current patient, who is a male. Apparently, 20% of females will experience this at one point or another in their lives, especially on the hands (Dunphy et al., 2011). Thus, "women are twice as men to develop dermatitis and are at highest risk after childbirth" (Dunphy et al., 2011). Risks include the fact that some patients may not have recognized previous outbreaks before. Thus, "often, the patient is not ware of a previous history, but there may have been periodic episodes of pruritic rash that resolved spontaneously" (Dunphy et al., 2011). Moreover, exposure to cosmetics and other chemicals can also increase risk.

Pharmaceutical Preparations

Over the counter creams are often most widely used because of the short duration of symptoms. This often includes Calamine lotion. Prescription of topical steroids is also common. Systemic treatments include oral steroids that will help relieve symptoms in 12 to 14 hours (Dunphy et al., 2011).

Health Promotion and Prevention Strategies

Allergy testing and patient awareness of their skins' reaction to certain chemicals or substances is key for prevention. Patients need to be aware of what chemicals and substances they use in order to detect what possibly might be causing the reaction.

References

Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2011) Primary care: The art…