Management Plan by Jade Brown on case Daisie Blankenship*
Problem Statement- A 25-year-old Caucasian female visits the clinic today, reporting a rash that
originated on her upper thighs and extended to her left inner forearm within the past 24 hours. She
recounts a recent hiking experience with her boyfriend, where they lost the trail and engaged in
bushwhacking. Despite wearing shorts without socks in approximately 98-degree weather, she admits
to insect bites during their off-trail adventure.
Additionally, she used a new suntan lotion, experimented with new foods, and spent time in a hot tub
with her boyfriend. Upon examination presence of itchy erythematous papules on her left inner forearm
and bilateral inner thighs. Vitals WNL, exam unremarkable, and family information unchanged from last
visit.
Contact dermatitis (ICD-10 code: L25.9), can arise from exposure to environmental substances, leading
to allergic reactions such as allergic contact dermatitis. Skin irritation is a hallmark of this condition,
triggered by direct contact with allergens or irritants, prompting an immunological response. Symptoms
range from redness, itching, and swelling to the formation of blisters or dry, scaly areas. Identifying the
cause and avoiding it is key, along with employing treatments like topical corticosteroids,
antihistamines, or moisturizers (Chan & Zug, 2021). As per the guidelines outlined by the American
Academy of Dermatology (AADA, 2021), recommended treatments encompass strategies such as
irritant avoidance, the utilization of prescribed and over-the-counter medications, cold compresses, and
the incorporation of oatmeal baths to alleviate pruritus.
Urticaria, commonly known as hives, manifests as sudden itchy, elevated lumps or welts on the skin,
varying in color, size, and shape (Corazza et al., 2019). Described as ranging from small as a pencil
eraser to large as a dinner plate, these welts can merge into larger swellings. Key triggers for urticaria
encompass allergic reactions to foods, medications, insect bites, or environmental factors like pollen
and pet dander. Additionally, physical factors like pressure, heat, or cold can induce this skin condition.
Bacterial folliculitis occurs when hair follicles get irritated and infected by bacteria. Characterized by
small red pustules, often accompanied by itching, discomfort, and occasional pain around the affected
hair follicles, these symptoms define the condition. Folliculitis may arise when hair follicles are irritated
or damaged, which can result from activities like shaving, clothing friction, or exposure to inadequately
disinfected hot tubs and pools (de Groot & Rustemeyer, 2023). Notably, folliculitis is more likely to
develop in areas of the skin subject to increased friction.
Atopic dermatitis is a chronic inflammatory skin condition characterized by pruritic, erythematous
papules and plaques. Considering the acute onset and the specific circumstances surrounding the hiking
trip, a more plausible explanation is an irritant contact dermatitis or an allergic reaction to one of the
newly introduced substances.
Treatment Plan
Medications: Triamcinolone 0.1 applied 1-2 times daily for 7 days
Benadryl 25 mg PO nightly PRN to help with itching and sleeping
Utilizing topical corticosteroids like hydrocortisone cream can also alleviate symptoms of allergic contact
dermatitis, reducing inflammation and relieving itching. Avoid potential irritants such as sudden
changes in soaps and lotions to prevent allergic responses. Wear protective clothing, especially
outdoors, to prevent skin irritation, and apply sunscreen when spending extended time in the sun.
Emphasized the importance of refraining from scratching and maintaining cleanliness in the affected
area.
Follow up: 1 week to evaluate progress
Call if your symptoms worsen and not improving. Go to the ER if you start have a fever, shortness of
breath, difficulty breathing, or chest pain.
Referrals: None recommended at this time but if symptoms not improved at follow up will recommended
dermatologist and allergist referral
Labs/Diagnostic Test: None recommended at this time
, Health promotion: Emphasized the avoidance of known allergens and irritants. Regular moisturizing to
preserve the skin's natural barrier function and advocate for gentle cleansing with fragrance-free soaps.
Choose skincare
Problem Statement- A 25-year-old Caucasian female visits the clinic today, reporting a rash that
originated on her upper thighs and extended to her left inner forearm within the past 24 hours. She
recounts a recent hiking experience with her boyfriend, where they lost the trail and engaged in
bushwhacking. Despite wearing shorts without socks in approximately 98-degree weather, she admits
to insect bites during their off-trail adventure.
Additionally, she used a new suntan lotion, experimented with new foods, and spent time in a hot tub
with her boyfriend. Upon examination presence of itchy erythematous papules on her left inner forearm
and bilateral inner thighs. Vitals WNL, exam unremarkable, and family information unchanged from last
visit.
Contact dermatitis (ICD-10 code: L25.9), can arise from exposure to environmental substances, leading
to allergic reactions such as allergic contact dermatitis. Skin irritation is a hallmark of this condition,
triggered by direct contact with allergens or irritants, prompting an immunological response. Symptoms
range from redness, itching, and swelling to the formation of blisters or dry, scaly areas. Identifying the
cause and avoiding it is key, along with employing treatments like topical corticosteroids,
antihistamines, or moisturizers (Chan & Zug, 2021). As per the guidelines outlined by the American
Academy of Dermatology (AADA, 2021), recommended treatments encompass strategies such as
irritant avoidance, the utilization of prescribed and over-the-counter medications, cold compresses, and
the incorporation of oatmeal baths to alleviate pruritus.
Urticaria, commonly known as hives, manifests as sudden itchy, elevated lumps or welts on the skin,
varying in color, size, and shape (Corazza et al., 2019). Described as ranging from small as a pencil
eraser to large as a dinner plate, these welts can merge into larger swellings. Key triggers for urticaria
encompass allergic reactions to foods, medications, insect bites, or environmental factors like pollen
and pet dander. Additionally, physical factors like pressure, heat, or cold can induce this skin condition.
Bacterial folliculitis occurs when hair follicles get irritated and infected by bacteria. Characterized by
small red pustules, often accompanied by itching, discomfort, and occasional pain around the affected
hair follicles, these symptoms define the condition. Folliculitis may arise when hair follicles are irritated
or damaged, which can result from activities like shaving, clothing friction, or exposure to inadequately
disinfected hot tubs and pools (de Groot & Rustemeyer, 2023). Notably, folliculitis is more likely to
develop in areas of the skin subject to increased friction.
Atopic dermatitis is a chronic inflammatory skin condition characterized by pruritic, erythematous
papules and plaques. Considering the acute onset and the specific circumstances surrounding the hiking
trip, a more plausible explanation is an irritant contact dermatitis or an allergic reaction to one of the
newly introduced substances.
Treatment Plan
Medications: Triamcinolone 0.1 applied 1-2 times daily for 7 days
Benadryl 25 mg PO nightly PRN to help with itching and sleeping
Utilizing topical corticosteroids like hydrocortisone cream can also alleviate symptoms of allergic contact
dermatitis, reducing inflammation and relieving itching. Avoid potential irritants such as sudden
changes in soaps and lotions to prevent allergic responses. Wear protective clothing, especially
outdoors, to prevent skin irritation, and apply sunscreen when spending extended time in the sun.
Emphasized the importance of refraining from scratching and maintaining cleanliness in the affected
area.
Follow up: 1 week to evaluate progress
Call if your symptoms worsen and not improving. Go to the ER if you start have a fever, shortness of
breath, difficulty breathing, or chest pain.
Referrals: None recommended at this time but if symptoms not improved at follow up will recommended
dermatologist and allergist referral
Labs/Diagnostic Test: None recommended at this time
, Health promotion: Emphasized the avoidance of known allergens and irritants. Regular moisturizing to
preserve the skin's natural barrier function and advocate for gentle cleansing with fragrance-free soaps.
Choose skincare
