A 5-year-old child and her mother present to your clinic. The mother reports that the child has had a cough and sounds “wheezy” for the last 2 days. She states that the child always gets like this when she is sick. She also reports that the child has been complaining that her right ear hurts. In addition, you notice dry scaly patches on the child’s elbows and behind her knees.
What are your three differentials and primary diagnosis? What would you prescribe for each condition? Remember to include your rationales.
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Expectations
Initial Post:
Length: A minimum of 275 words, not including references
Citations: At least five high-level scholarly references in APA 7 from within the last 5 years
Sample Paper
Primary Diagnosis
The most likely primary diagnosis is atopic dermatitis. It refers to a chronic disease caused by the inability of the skin to protect the body from irritants and allergens. The condition usually flares up periodically and is often associated with asthma or hay fever, thus sometimes associated with cough and wheezing. It also makes the skin red and itchy, particularly around the hands, ankles, feet, eyelids, elbows and knees. It is most common in children (Fuxench et al.,2019).
The rationale for the diagnosis is the patient presents with the primary atopic dermatitis symptoms, which include dry, scaly patches on the elbows and behind the knees. She also presents with a cough that wheezing, commonly associated with atopic dermatitis. Besides, the patient’s age of 5 years increases the risk of the condition. The mother also reports that the symptoms always appear periodically. Recurrence of the symptoms can affect the upper respiratory system and the ear canal, spreading to the ear and causing ear infections. Thus, the condition is sometimes associated with ear pain. Treatment entails a corticosteroid cream to control itching and help repair the skin, an antibiotic to prevent the infection (Frazier & Bhardwaj, 2020).
Differential Diagnosis
Another possible diagnosis is seborrheic dermatitis. It refers to a common skin condition that affects the scalp, causing skin redness, scaly patches, and dandruff. The rationale for the diagnosis is the patient presents with dry, scaly patches; however, in Seborrheic dermatitis, the patches mainly affect the oily areas of the body, such as the face and chest. Treatment entails antifungal shampoo, gel, cream, and pills to control the growth and spread of infection (Alrashidi et al., 2021).
The other possible diagnosis is psoriasis. Psoriasis is a skin disease caused by an immune system problem that causes the skin to regenerate faster than normal, resulting in red, itchy, scaly patches. The symptoms mostly affect areas around the knees, elbows, trunk, and scalp. The rationale for the diagnosis is the patient presents with these symptoms. Besides, the condition is chronic and periodic, just as the mother describes the patient’s symptoms. However, the condition is not associated with coughing or wheezing. Treatment entails stopping skin cells from overgrowing and removing scales using phototherapy and topical therapy, such as Corticosteroids (Micali et al., 2019).
The other differential diagnosis is neurodermatitis. The skin condition is lifelong and recurrent and starts with an itchy skin patch. The rationale for the diagnosis is the patient presents with itchy patches. However, the condition is not associated with cough and wheezing. Treatment entails Anti-itch medicated creams and Corticosteroid injections to facilitate skin healing (Peng et al., 2020).
References
Alrashidi, A. S. M. A., Alasafra, Z. O. A., Aljubran, Z. N., Almutairi, M. F. H., & Alsaeed, M. I. (2021). Review on Seborrheic Dermatitis Diagnosis and Treatment in Primary Health Care Center. Archives of Pharmacy Practice, 1, 35. https://archivepp.com/storage/files/article/f6477cef-4787-4200-b8e7-a452ca9b6c31-8VFrnaDl0qFOpyJo/archiveapp-vol12-iss4-35-37-1261.pdf
Frazier, W. T., & Bhardwaj, N. (2020). Atopic dermatitis: diagnosis and treatment. American family physician, 101(10), 590-598. https://www.aafp.org/afp/2020/0515/p590.html
Fuxench, Z. C. C., Block, J. K., Boguniewicz, M., Boyle, J., Fonacier, L., Gelfand, J. M., … & Ong, P. Y. (2019). Atopic dermatitis in America study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. Journal of Investigative Dermatology, 139(3), 583-590. https://doi.org/10.1016/j.jid.2018.08.028
Micali, G., Verzì, A. E., Giuffrida, G., Panebianco, E., Musumeci, M. L., & Lacarrubba, F. (2019). Inverse psoriasis: From diagnosis to current treatment options. Clinical, cosmetic and investigational dermatology, 12, 953. https://dx.doi.org/10.2147%2FCCID.S189000
Peng, L., Yu, Q., Zhang, J., Mi, X., Lin, W., Qin, Y., … & Chen, M. (2020). Cupping for neurodermatitis: A protocol of systematic review and meta-analysis. Medicine, 99(40). https://dx.doi.org/10.1097%2FMD.0000000000022586
