Skin Diagnosis

Write a paragraph response for the scenario below using one of the following:
Critique your colleagues clinical description of the physical characteristics of each.
Suggest an additional possible condition for each graphic, and explain your reasoning.
Provide an alternative correct diagnosis, and explain your reasoning.
Validate an idea with your own experience and additional research.

Include one to two reference within the last five years for each paragraph.

Classroom Resources:
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby. (chapters 8)
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby. (chapter 28)
Clothier, A. (2014). Assessing and managing skin tears in older people. Nurse Prescribing, 12(6), 278282. Retrieved from
Watkins, J. (2013a). Skin rashes, part 1: Skin structure and taking a dermatological history. Practice Nursing, 24(1), 3033. doi:10.12968/pnur.2013.24.1.30
Retrieved from the Walden Library
Watkins, J. (2013b). Skin rashes, part 2: Distribution and different types of rashes. Practice Nursing, 24(3), 124127. Retrieved from from the Walden Library
Watkins, J. (2013c). Skin rashes, part 3: localized rashes. Practice Nursing, 24(5), 235241. doi:10.12968/pnur.2013.24.5.235
Retrieved from the Walden Library Databases.
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowins diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
Chapter 6, The Skin and Nails

Case 1

Graphic 1 Characteristics

Chief complaint- Patient A is complaining of a purple discoloration to their skin.
History of Present Illness- Patient A is a 65-year-old male, that reports feeling fine, but noticed some discoloration. The area appears to be approximately one centimeter in diameter with an irregular border. Patient denies any traumatic injury to the area, but admits he can be clumsy at times. Patient appears well groomed and nourished.
Lopressor 50mg BID
Cardizem 120mg daily
Coumadin 5mg every evening
Aspirin 325mg daily
Multivitamin daily
Past Medical History- Hypertension, atrial fibrillation, hyperlipidemia
Physical Exam- Vital Signs- BP 128/86, right arm, sitting, P 76, regular, T 98.5 orally, RR 18; non-labored. Patient is A&O x3, appears comfortable, no further skin abnormalities. The skin in question is not raised upon palpation, but does cause the patient mild discomfort.
Differential Diagnosis-
Ecchymosis related to Coumadin use. The patient is unsure of what their last INR level was. Patient needs to have bloodwork drawn to determine INR level. If INR is elevated, there are many side effects that could occur, such as bleeding and this type of ecchymosis (Web MD, 2017a).
Pigmentary changes due to endocrine and metabolic disease. These can be similar to drug induced pigment changes (Petros, 2009). Patient would need to get bloodwork drawn to determine metabolic function, like BUN, creatinine, electrolytes, liver function panel, TSH, etc.
Cutaneous malignant melanoma. Pigment changes in the skin of various colors (blue, brown, black, red) occur as tumor cells migrate through the epidermis and dermis at various speeds and directions (Petros, 2009, para. 4). Patient would need a biopsy and to see a dermatology or oncology specialist.
Plan- Patient will obtain necessary bloodwork. Correct diagnosis is most likely ecchymosis related to Coumadin use. Even if the patients INR is in a therapeutic range, ecchymosis can still occur easily. Patient will need to be more cautious moving forward.
SOAP for Picture 5

Chief complaint- Patient B is complaining of dry, itchy patches of skin on his forearm.
History of Present Illness- Patient B is a 26-year-old male that has developed dry patches of skin on his left forearm. They have been present for approximately one week. Patient states he has been feeling stressed from work, but ok otherwise.
None reported.
Past Medical History- Anxiety, depression
Physical Exam- Vital Signs- BP 140/88, right arm, sitting, P 96, regular, T 98.8 orally, RR 16; non-labored. Patient is A&O x3, appears tired. Skin in question is very dry upon palpation.
Differential Diagnosis-
1 Tinea Corporis. Infection that can occur on the legs, arms, or trunk cause by dermatophyte fungus (DermNet New Zealand, 2003). This can present rather quickly and appears as itchy, inflamed, red patches.
2 Psoriasis. Characterized by plaques of red skin with loose, silver-colored scales and can be painful or itch (WebMD, 2017b). Typically, presents on knees, elbows, scalp, or soles of the feet (WebMD, 2017b).
3 Eczema (dermatitis). Dry, itchy skin. Skin can turn red if it has been scratched and can begin to swell (MedlinePlus, 2017). Can be induced by irritants like soaps or detergents and exacerbated by stress.
Plan- Patient states he has been stressed leading to the most likely diagnosis of eczema or dermatitis. Patient needs to avoid itching the area, apply topical steroids, and lubricate or moisturize the area two to three times a day with an ointment like petroleum jelly (Medline Plus, 2017). Ensure the ointment is alcohol, scent, dye, and fragrance free.
DermNet New Zealand. (2003). Tinea corporis. Retrieved from

Petros, H. M. (2009). Whats your assessment? Dermatology Nursing 21(6): 327-335. Retrieved from

Medline Plus. (2017). Eczema. Retrieved from

Web MD. (2017a). Coumadin. Retrieved from

Web MD. (2017b). Understanding psoriasis- the basics. Retrieved from

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