Integument Disorders

Based on information missing from the patient history, suggest other possible diagnoses and explain why. . V. 50-year-old patient with history of eczema is here today complaining of lesions on the right side of her face and neck. She thinks it is a flare up of her eczema and is asking for a refill of her ointment, TAC 0.1%. She complains of some ‘itching’ and a bit of ‘tingling and pain’ to the lesions. She’s a pharmaceutical worker and thinks that the ‘pain’ maybe due to contaminate exposure. Denies any other associating symptoms. Below is a photo of the lesions. Primary Diagnosis Shingles: Shingles (herpes zoster) is caused by recurrence of a latent varicella zoster virus. Causes abnormal skin sensations and pain in the affected dermatome. Causes a vesicular rash and is unilateral. Can be intensely painful and itchy, and have tingling or numbness (Galloway, 2016). Prescriptions(s): Antiviral drugs such as Aciclovir: 800 mg, five times a day for 7 days (Galloway, 2016). Interventions/ lifestyle changes: N/A Referrals: Not needed unless patient has ophthalmic shingles then it is emergent and needs to see ophthalmologist immediately (Galloway, 2016). Follow up: N/A unless have another outbreak. Education: Educate patients age 65 and older about vaccine available for shingles. Teach side effects of any medication prescribed. Educated that this is contagious (Galloway, 2016). Differential Diagnosis Contact Dermatitis: Is an inflammation of the skin when it comes in contact with an allergen. It is usually on the hand. Treatment includes keeping the area clean and dry (Sharma, Mahajan, Mehta, & Chauhan, 2014). Asteatotic eczema: Type of eczema often seen in the elderly. Skin is rough, dry, scaly, and cracked. Treatment is keeping the skin moisturized, can also include steroids (Sutherland, 2018). Drug eruptions: Drug related drug eruptions can occur in people as a reaction to medication. Often more common in elderly people as they are on more medications typically. This type of reaction can be mild to life threatening. Treatment can be as simple as discontinuing the causative medication or giving antihistamines or steroids (Sutherland, 2018). References Galloway, M. (2016). Shingles: prevention and management. Practice Nurse, 46(9), 18–22. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=119524590&site=eds-live&scope=site Sharma, V., Mahajan, V. K., Mehta, K. S., & Chauhan, P. S. (2014). Occupational contact dermatitis among construction workers: Results of a pilot study. Indian Journal of Dermatology, Venereology & Leprology, 80(2), 159–161. https://doi-org.ezp.waldenulibrary.org/10.4103/0378-6323.129402 Sutherland, M. (2018). Eczema conditions in the older person. British Journal of Community Nursing, 23(6), 234–238. https://doi-org.ezp.waldenulibrary.org/10.12968/bjcn.2018.23.6.234                                                                                                                                                

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