i-Human Case Study: Week 4 – 13-Year-Old Female
with Itchy Skin
a) HPI Statement (15% of grade)
Chief Complaint: "Itchy rash for the past 10 days."
History of Present Illness:
The patient is a 13-year-old female who presents with a generalized, intensely
pruritic rash that began approximately 10 days ago. The rash initially started as small,
red bumps on the antecubital and popliteal fossae and has since spread to involve
the wrists, ankles, and neck. The patient reports that the itching is worse at night,
often interfering with sleep. She notes that the rash becomes more erythematous
and inflamed after scratching. She has tried over-the-counter hydrocortisone cream
and oral diphenhydramine at bedtime, with minimal relief. She denies any recent
illnesses, fevers, chills, joint pain, or mucosal involvement. No known sick contacts or
recent travel. The rash is not painful but is described as "burning" after scratching.
She reports a history of mild eczema as a child, which resolved around age 8. No
previous similar episodes in recent years.
b) History (10% of grade)
Review of Systems:
• General: Denies fever, chills, fatigue, or weight changes.
• Skin: Itchy, dry, erythematous patches; worse at night; no blisters, oozing, or crusting
noted by patient.
• Respiratory: Denies cough, wheezing, or shortness of breath.
• Gastrointestinal: Denies nausea, vomiting, diarrhea, or abdominal pain.
• Allergy/Immunology: Reports seasonal allergies (pollen) in spring; no known food
or drug allergies.
• Psychosocial: Reports increased stress due to recent exams; no anxiety or
depression diagnosis.
Past Medical History:
• Atopic dermatitis (childhood, resolved)
, • Seasonal allergic rhinitis
Medications:
• Diphenhydramine 25 mg PO at bedtime (as needed, minimal relief)
• Hydrocortisone 1% cream (topical, minimal relief)
Allergies:
• No known drug allergies
Family History:
• Mother: Asthma, seasonal allergies
• Father: Allergic rhinitis
• Sibling: Eczema
Social History:
• Lives with parents and younger sibling
• Attends 8th grade; active in soccer
• No smoking, alcohol, or drug use
• Denies use of new soaps, detergents, or lotions
c) Physical Exam (10% of grade)
Vitals:
• Temperature: 98.6°F (37.0°C)
• Heart Rate: 78 bpm
• Respiratory Rate: 16/min
• Blood Pressure: 110/68 mmHg
• O2 Saturation: 99% on room air
General: Well-appearing, alert, and cooperative. No acute distress.
Skin:
• Symmetrical, erythematous, excoriated papules and plaques noted in bilateral
antecubital and popliteal fossae.
• Dry, scaly patches with lichenification noted on wrists, ankles, and posterior neck.
• No vesicles, bullae, or purulent drainage.
with Itchy Skin
a) HPI Statement (15% of grade)
Chief Complaint: "Itchy rash for the past 10 days."
History of Present Illness:
The patient is a 13-year-old female who presents with a generalized, intensely
pruritic rash that began approximately 10 days ago. The rash initially started as small,
red bumps on the antecubital and popliteal fossae and has since spread to involve
the wrists, ankles, and neck. The patient reports that the itching is worse at night,
often interfering with sleep. She notes that the rash becomes more erythematous
and inflamed after scratching. She has tried over-the-counter hydrocortisone cream
and oral diphenhydramine at bedtime, with minimal relief. She denies any recent
illnesses, fevers, chills, joint pain, or mucosal involvement. No known sick contacts or
recent travel. The rash is not painful but is described as "burning" after scratching.
She reports a history of mild eczema as a child, which resolved around age 8. No
previous similar episodes in recent years.
b) History (10% of grade)
Review of Systems:
• General: Denies fever, chills, fatigue, or weight changes.
• Skin: Itchy, dry, erythematous patches; worse at night; no blisters, oozing, or crusting
noted by patient.
• Respiratory: Denies cough, wheezing, or shortness of breath.
• Gastrointestinal: Denies nausea, vomiting, diarrhea, or abdominal pain.
• Allergy/Immunology: Reports seasonal allergies (pollen) in spring; no known food
or drug allergies.
• Psychosocial: Reports increased stress due to recent exams; no anxiety or
depression diagnosis.
Past Medical History:
• Atopic dermatitis (childhood, resolved)
, • Seasonal allergic rhinitis
Medications:
• Diphenhydramine 25 mg PO at bedtime (as needed, minimal relief)
• Hydrocortisone 1% cream (topical, minimal relief)
Allergies:
• No known drug allergies
Family History:
• Mother: Asthma, seasonal allergies
• Father: Allergic rhinitis
• Sibling: Eczema
Social History:
• Lives with parents and younger sibling
• Attends 8th grade; active in soccer
• No smoking, alcohol, or drug use
• Denies use of new soaps, detergents, or lotions
c) Physical Exam (10% of grade)
Vitals:
• Temperature: 98.6°F (37.0°C)
• Heart Rate: 78 bpm
• Respiratory Rate: 16/min
• Blood Pressure: 110/68 mmHg
• O2 Saturation: 99% on room air
General: Well-appearing, alert, and cooperative. No acute distress.
Skin:
• Symmetrical, erythematous, excoriated papules and plaques noted in bilateral
antecubital and popliteal fossae.
• Dry, scaly patches with lichenification noted on wrists, ankles, and posterior neck.
• No vesicles, bullae, or purulent drainage.
