i-Human Case Study Week #4: 13-
Year-Old Female Presenting with
Itchy Skin – Complete HPI, ROS,
Physical Examination, Differential
Diagnosis, and Management
I
Human case study week#4 13year-old female with itchy skin
Patient Demographic
Name: Emma R. (fictional)
Age: 13 years
Gender: Female
Chief Complaint: “I can’t stop scratching. It’s keeping me up at
night.”
, II. History of Present Illness (HPI)
Emma is a 13-year-old female who presents with a chief
complaint of generalized pruritus for the past 3 weeks. The itch
began on the flexural surfaces of the elbows and knees and has
since spread to the neck, wrists, and ankles. She describes the
sensation as intense, “like a crawling or burning” feeling, which
worsens at night. She reports that scratching provides temporary
relief but often leads to bleeding points.
OLDCARTS Framework:
Onset: Gradual, began 3 weeks ago.
Location: Started bilaterally in antecubital and popliteal fossae;
now involves posterior neck, wrists, and dorsum of feet. Sparing of
the diaper area (relevant given age).
Duration: Persistent, with nocturnal exacerbations.
Character: Dry, red, scaly patches; “rough like sandpaper.” Patient
reports visible “little bumps” that ooze clear fluid when scratched.
Aggravating Factors: Synthetic clothing (polyester), sweating
during gym class, stress (recent exams), hot showers.
Relieving Factors: Cool compresses, over-the-counter 1%
hydrocortisone cream (minimal relief), moisturizing with
ceramide-based cream.
Timing: Worse in the evening and during sleep; mother reports
patient wakes up scratching.
Severity: Self-rated 8/10 during exacerbations; 4/10 at baseline.
Associated Symptoms:
Year-Old Female Presenting with
Itchy Skin – Complete HPI, ROS,
Physical Examination, Differential
Diagnosis, and Management
I
Human case study week#4 13year-old female with itchy skin
Patient Demographic
Name: Emma R. (fictional)
Age: 13 years
Gender: Female
Chief Complaint: “I can’t stop scratching. It’s keeping me up at
night.”
, II. History of Present Illness (HPI)
Emma is a 13-year-old female who presents with a chief
complaint of generalized pruritus for the past 3 weeks. The itch
began on the flexural surfaces of the elbows and knees and has
since spread to the neck, wrists, and ankles. She describes the
sensation as intense, “like a crawling or burning” feeling, which
worsens at night. She reports that scratching provides temporary
relief but often leads to bleeding points.
OLDCARTS Framework:
Onset: Gradual, began 3 weeks ago.
Location: Started bilaterally in antecubital and popliteal fossae;
now involves posterior neck, wrists, and dorsum of feet. Sparing of
the diaper area (relevant given age).
Duration: Persistent, with nocturnal exacerbations.
Character: Dry, red, scaly patches; “rough like sandpaper.” Patient
reports visible “little bumps” that ooze clear fluid when scratched.
Aggravating Factors: Synthetic clothing (polyester), sweating
during gym class, stress (recent exams), hot showers.
Relieving Factors: Cool compresses, over-the-counter 1%
hydrocortisone cream (minimal relief), moisturizing with
ceramide-based cream.
Timing: Worse in the evening and during sleep; mother reports
patient wakes up scratching.
Severity: Self-rated 8/10 during exacerbations; 4/10 at baseline.
Associated Symptoms:
