A presumptive nursing diagnosis can be made based on data analysis obtained from medical history, subjective verbal reports, and laboratory results (Herdman & Kamitsuru, 2014). This paper aims to outline three initial differential diagnoses for a patient who presents with complaints of red, itching skin areas.
Seborrheic dermatitis is the first differential diagnosis for the patient. Alex’s lesions are located on his scalp, nasolabial folds, and groin. The presentation and distribution of lesions allow making a clinical diagnosis (Clark, Pope, & Jaboori, 2015; Goldenberg, 2013). In terms of pathophysiology, the clinical manifestations of the condition are associated with the effect of Malassezia yeast on the normal functioning of skin cells (Clark et al., 2015). Upon entering the stratum corneum, the yeast releases lipases that initiate inflammation (Clark et al., 2015). The disease appears in 40 to 80 percent of individuals with human immunodeficiency virus (HIV) (Mameri, Carneiro, Mameri, Cunha, & Silva, 2017). Therefore, it is necessary to inquire whether Alex is HIV-positive. To rule in the diagnosis, a healthcare professional must examine the distribution of the affected skin areas. It is expected that the patient’s scalp is affected as well. The previous history of Parkinson’s disease or mood disorders are the expected history findings (Mameri et al., 2017). To confirm the diagnosis, it is necessary to conduct a biopsy to detect parakeratosis in the epidermis or spongiosis (Clark et al., 2015).
Given that the patient has recently had unprotected sex, it is necessary to consider secondary syphilis as the second differential diagnosis. Syphilis is caused by one of the following genera of spirochetes: Treponema, Borrelia, and Leptospira (Chandrasekar, 2017). A history question that should be asked is whether Alex has previously treated syphilis. It has to do with the fact that secondary syphilis develops if primary syphilis is untreated (Chandrasekar, 2017). A solitary genital chancre and plaques on palms may be discovered during a physical examination (Mattei, Beachkofsky, Gilson, & Wisco, 2012). Pink macules can also be discovered on the patient’s body. The physical examination of lesions will not suffice to rule in or out the diagnosis; therefore, it is necessary to examine lesions with dark-field microscopy, which may show treponemes (Mattei et al., 2012).
This form of psoriasis occurs in patients without previous history of psoriasis (Raychudhuri, Maverakis, & Raychaudhuri, 2014). Psoriasis is a multifactorial disease of a genetic origin. When triggered, the epidermis is infiltrated by leukocytes, which causes the creation of characteristic reddish plaques (Raychudhuri et al., 2014). The condition is characterized by rapid onset. A physical examination may show “round erythematous exanthema of generally less 1 cm size over the trunk and extremities in a centripetal fashion” (Raychudhuri et al., 2014, p. 491).
Medication for Seborrheic Dermatitis
Ketoconazole 2% shampoo (120 ml) should be applied to the affected areas once a day for one week, then twice a week for three weeks (Clark et al., 2015). Facial areas can be treated with Ciclopirox 0.77% cream (90g) twice a day for up to four weeks (Clark et al., 2015). If no improvement of the symptoms occurs, it is necessary to reconsider the diagnosis.
Alex should be informed that seborrheic dermatitis is a recurring condition; therefore, he should expect future relapses (Goldenberg, 2013). He should be advised against scratching his lesions. The patient has to know that a skin biopsy is a painless procedure that does not require special preparation. Alex will be informed that burning and irritation are common adverse effects of his medication (Clark et al., 2015). He should be examined once again in four weeks.
The paper has outlined the following differential diagnoses for the patient: seborrheic dermatitis, secondary syphilis, and guttate psoriasis. The paper has also presented medication for seborrheic dermatitis and discussed the education necessary for the condition.
Chandrasekar, P. H. (2017). Syphilis. Web.
Clark, G. W., Pope, S. M., & Jaboori, K. A. (2015). Diagnosis and treatment of seborrheic dermatitis. American Family Physician, 91(3), 185-190.
Goldenberg, G. (2013). Optimizing treatment approaches in seborrheic dermatitis. The Journal of Clinical and Aesthetic Dermatology, 6(2), 44-49.
Herdman, T., & Kamitsuru, S. (2014). NANDA International: nursing diagnoses. Hoboken, NJ: John Wiley & Sons.
Mameri, A. C. A., Carneiro, S., Mameri, L. M. A., Cunha, T. J. M., & Silva, R. M. (2017). History of seborrheic dermatitis: Conceptual and clinic-pathologic evolution. Skinmed, 15(3), 187-194.
Mattei, P. L., Beachkofsky, T. M., Gilson, R. T., & Wisco, R. T. (2012). Syphilis: A reemerging infection. American Family Physician, 86(5), 433-440.
Raychudhuri, S. K., Maverakis, E., & Raychaudhuri, S. P. (2014). Diagnosis and classification of psoriasis. Autoimmunity Reviews, 13(1), 490-495.