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 differentials and diagnosis? What would you prescribe for each condition? Remember to include your rationales.
Length: A minimum of 275 words, not including references
Citations: At least 2 high-level scholarly reference in APA-7 from within the last 5 years
Following the case, a kid who presented in the clinic accompanied by her mother had complaints of coughs and wheezing sounds, right ear pains, and dry, scaly patches on her elbows and behind the knees. As a result, it would thus be essential to complete a comprehensive history and physical assessment. These assessments are significant as they can afford information that may lead to the kid’s diagnosis and form a basis for a plan of management.
In this case, one differential diagnosis would be Atopic dermatitis. Also known as eczema, this disorder makes an individual’s skin red and itchy (Danby & Cork, 2018). It is common in kids but may occur at any age. It is characterized by signs and symptoms such as dry skin, itching, red to brownish-gray spots, mainly on feet, hands, neck, ankles, eyelids, wrists, inside the bend of knees and elbows, and in kids, and thickened, scaly, cracked skin. Here, the patient’s right ear pain can relate to Atopic eczema. A common site of ear eczema in individuals with atopic eczema is a junction between the earlobe and face. Eczema in this area may cause painful cracks in the skin that can become infected. When it comes to Atopic eczema and coughs, roughly 20 percent of individuals having atopic dermatitis correspondingly have asthma, an allergic disorder that triggers airways to become inflamed, narrow and swollen. This narrowing makes breathing hard, leading to chest tightness, coughing, and wheezing.
Another significant differential diagnosis would be Psoriasis. This skin condition triggers red, itchy, scaly patches, mainly on the knees, elbows, and scalp and on the trunk (Brandon, Mufti & Sibbald, 2019). Psoriasis can be characterized by red skin patches covered with thick, silvery scales, tiny scaling spots in kids, itching or burning, and dry, cracked skin that may itch or bleed.
Diagnosis and Prescriptions
On diagnosis for Atopic dermatitis, no lab test would be essential. Though, diagnosis may be completed by examining the patient’s skin and reviewing medical history. Patch testing may similarly be applied to define other skin conditions or find those accompanying eczema. It would be good to recommend creams that control itching for prescriptions, helping repair skin. For instance, a corticosteroid cream or ointment can fit here to be applied as directed either once or twice every day (Reich et al., 2021).
For diagnosis of Psoriasis, it would be good to ask questions on the patient’s health and examine her skin, scalp, and nails. A biopsy can also be taken for examination under a microscope to help define the type of Psoriasis, ruling out other conditions. It would be good to prescribe corticosteroids for Psoriasis, i.e., topical corticosteroids to be applied once every day during the flares and on alternative days to maintain remission (Brandon, Mufti & Sibbald, 2019).
Brandon, A., Mufti, A., & Sibbald, R. G. (2019). Diagnosis and management of cutaneous Psoriasis: a review. Advances in skin & wound care, 32(2), 58-69. Doi: 10.1097/01.ASW.0000550592.08674.43
Danby, S. G., & Cork, M. J. (2018). PH in atopic dermatitis. PH of the Skin: Issues and Challenges, 54, 95-107. https://doi.org/10.1159/000489523
Reich, K., Teixeira, H. D., de Bruin-Weller, M., Bieber, T., Soong, W., Kabashima, K., & Silverberg, J. I. (2021). Safety and efficacy of upadacitinib in combination with topical corticosteroids in adolescents and adults with moderate-to-severe atopic dermatitis (AD Up): results from a randomized, double-blind, placebo-controlled phase 3 trial. The Lancet, 397(10290), 2169-2181. https://doi.org/10.1016/S0140-6736(21)00589-4