Question:
What would you consider as differential diagnoses and why? Based on the presentation here, what would you consider being the final diagnosis, and what is your recommended plan of treatment and management? What physical exam findings support your final diagnosis?
Answer:
The differential diagnosis considered is contact dermatitis. Contact dermatitis is a kind of skin inflammation that results from allergens or irritants. Contact dermatitis is the localised irritation or rash that is caused by contact with a foreign substance. The superficial area of the skin is the only part affected by dermatitis. Contact dermatitis leads to itchy and burning rashes. Papules are formed on the effected area, and they may be pinpoint rashes growing in a linear pattern (Bolognia et al., 2014).
Based on the presentation of the patient, the final diagnosis would be scabies. This is because in scabies, patients have intense itching, especially at night (Monsel & Chosidow, 2015). The patient in this case has a very itchy rash that is keeping her up at night.
Scabies treatment includes administration of a scabicidal agent (eg, permethrin, lindane, or ivermectin), as well as an appropriate antimicrobial agent if a secondary infection has developed. Scabies will not go away on its own. It can only be cured with prescription medications that kill the mites. Treatment is to be done by a cream or lotion that is applied in the affected areas. It is to be left on for 8 to 14 hours and then washed off. To control itching, especially at night, antihistamine pills would be useful. Treatment takes up to three days, depending on the medication used. The members of the family of the patient would be adviced to avoid any close physical contact with the patient (Mounsey & McCarthy, 2013).
References
Bolognia, J. L., Schaffer, J. V., Duncan, K. O., & Ko, C. J. (2014).Dermatology Essentials E-Book. Elsevier Health Sciences.
Monsel, G., & Chosidow, O. (2015). 24. Scabies, lice, and myiasis. Clinical Infectious Disease, 162.
Mounsey, K. E., & McCarthy, J. S. (2013). Treatment and control of scabies. Current opinion in infectious diseases, 26(2), 133-139.
