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Question
Instructions
Reflect on a patient who presented with a dermatologic disorder during your Practicum experience. Describe your experience in assessing and managing the patient and his or her family. Include details of your “aha” moment in identifying the patient’s dermatologic disorder. Then, explain how the experience connected your classroom studies to the real-world clinical setting. If you did not have an opportunity to evaluate a patient with this background during the last 5 weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.
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Answer
Dermatological Disorder Diagnosis: Scabies
F.H., a 5-year-old male, presented to the clinic and with constant scratching as the chief complaint. The patient’s stated that the symptoms seemed to have developed about a month a go after the family has settled in new rural home after selling their home in an urban setting. On physical assessment, F.H. had masks all over his body from scratching. There was presence of white, raised and flesh-tone lines.
Differential diagnoses included scabies, potential exposure to poison ivy, and allergic reaction to cosmetics. The father denied having exposed his son to poison ivy since he has not moved to fields, forests, or any garden with F.H. in the last two months. As such, potential exposure to poison ivy was dropped from the differential diagnosis. Poison ivy causes an itchy vesicular eruption (Colbeck & Clayton, 2013). On the other hand, the boy’s mother denied having changed what she has been using as F.H.’s body ointment since birth; hence, allergic reaction to cosmetics was also dropped, leaving scabies as the presumptive final diagnosis. Clinical examination revealed visible white burros on dermoscopy and detection of feces, ova, and mite under light microscopy, which confirmed scabies as the final diagnosis (Anderson & Strowd, 2017).
The experience connected me with the classroom experience of differential diagnosis. In the classroom, I learnt of holistic care approach in which I applied in this case, since I went a step further to diagnose and treat the entire family. Besides, classroom experience taught me to consult evidence-based interventions so as to promote achievement of patient-centered care. Treatment included use of topical permethrin for F.H., and a combination of oral ivermectin and topical permethrin for treatment of F.H.’s father and mother (Anderson & Strowd, 2017). I also advised the family to have a thorough cleaning of all their garments before putting on to them again since the disease is highly contagious (Dressler et al., 2016).
References
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Anderson, K.L., & Strowd, L.C. (2017). Epidemiology, diagnosis, and treatment of scabies in a dermatology office. JABFM, 30(1), 78-84.
Colbeck, C., & Clayton, T.H. (2013). Poison ivy dermatitis. Archives of Disease in Childhood, 98(12). http://dx.doi.org/10.1136/archdischild-2013-305122
Dressler, C., Rosumeck, S., Sunderkotter, C., Werner, R.N., & Nast, A. (2016). The treatment of scabies. Dtsch Arztebl Int., 113(45), 757-762. DOI: 10.3238/arztebl.2016.0757.
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