Lab Assignment: Differential Diagnosis for Skin Conditions

Lab Assignment: Differential Diagnosis for Skin Conditions

Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.

In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.

Required readings

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 9, “Skin, Hair, and Nails”
This chapter reviews the basic anatomy and physiology of skin, hair, and nails. The chapter also describes guidelines for proper skin, hair, and nails assessments.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.
This section explains the procedural knowledge needed prior to performing various dermatological procedures.
Chapter 1, “Punch Biopsy

Download Chapter 1, “Punch Biopsy”
Chapter 2, “Skin Biopsy”
Download Chapter 2, “Skin Biopsy”
Chapter 10, “Nail Removal”
Download Chapter 10, “Nail Removal”
Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”
Download Chapter 15, “Skin Lesion Removals: Keloids, Moles, Corns, Calluses”
Chapter 16, “Skin Tag (Acrochordon) Removal”
Download Chapter 16, “Skin Tag (Acrochordon) Removal”
Chapter 22, “Suture Insertion”
Download Chapter 22, “Suture Insertion”
Chapter 24, “Suture Removal”

Download Chapter 24, “Suture Removal”

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 28, “Rashes and Skin Lesions”

Download Chapter 28, “Rashes and Skin Lesions”
This chapter explains the steps in an initial examination of someone with dermatological problems, including the type of information that needs to be gathered and assessed.
Note: Download and use the Student Checklist and the Key Points when you conduct your assessment of the skin, hair, and nails in this Week’s Lab Assignment.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1 and 3)

VisualDx. (2021). Clinical decision support
Links to an external site.: For professionals. Retrieved July 16, 2021, from http://www.skinsight.com/professionals
This interactive website allows you to explore skin conditions according to age, gender, and area of the body.
Bonifant, H., & Holloway, S. (2019). A review of the effects of ageing on skin integrity and wound healing
Links to an external site.. British Journal of Community Nursing, 24(Sup3), S28–S33. https://doi.org/10.12968/bjcn.2019.24.sup3.s28
Document: Skin Conditions
Download Skin Conditions (Word document)
This document contains images of different skin conditions. You will use this information in this week’s Discussion.
Document: Comprehensive SOAP Exemplar
Download Comprehensive SOAP Exemplar (Word document)
Document: Comprehensive SOAP Template

Download Comprehensive SOAP Template (Word document)

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

Shadow Health. (2021). Welcome to your introduction to Shadow Health

Links to an external site.. https://link.shadowhealth.com/Student-Orientation-Video
Shadow Health. (n.d.). Shadow Health help desk
Links to an external site.. Retrieved from https://support.shadowhealth.com/hc/en-us
Shadow Health. (2021). Walden University quick start guide: NURS 6512 NP students.
Download Walden University quick start guide: NURS 6512 NP students. https://link.shadowhealth.com/Walden-NURS-6512-Student-Guide
Document: Shadow Health Nursing Documentation Tutorial
Download Shadow Health Nursing Documentation Tutorial (Word document)
Document: DCE (Shadow Health) Documentation Template for Health History
Download DCE (Shadow Health) Documentation Template for Health History (Word document)
Use this template to complete your Assignment 2 for this week.

To Prepare

Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.
Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
Consider which of the conditions is most likely to be the correct diagnosis, and why.
Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.

The Lab Assignment

Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.

ORDER A CUSTOM-WRITTEN PAPER HERE

Skin Conditions

Subjective Data

CC: The patient presents with persistent and recurring razor bumps in the beard area.

HPI: The patient reports enduring discomfort and inflammation of facial hair follicles post-shaving. Initially, red lumps appeared in the beard area, evolving into painful pustules. Shaving exacerbates the symptoms, while allowing facial hair grow provides relief and the symptoms have lasted for six months.

Medications: N/A

Allergies: None

PMH: NA

PSH: NA

Personal/Social History: A 32-year-old male shaves his facial hair and mustache regularly. He affirms that he has not used any specific shaving products or methods that might be linked to the issue. He states that there are no workplace irritants or toxins.

Immunization History: No immunization history available.

Significant Family History: No family history for the disorder.

Review of Systems

General: Fatigue, weight loss, or fever absent.

HEENT: No sinus congestion, headache or any visual alterations noted.

Respiratory: No shortness of breath, cough, or wheezing.

Cardiovascular: No palpitations or chest pain.

Gastrointestinal: Does not have any abdominal pain, vomiting, nausea, or changes in bowel.

Genitourinary: NA.

Musculoskeletal: NA.

Neurological: NA.

Psychiatric: No  sleep disturbances, anxiety, depression.

Nails/skin/hair: The patient has razor bumps (milia) on the beard, which may be itchy, painful, and inflamed at times. Not any additional skin disorders have been identified.

Objective Data

Physical Exam: pulse, respiratory rate, vital signs, including, temperature and blood pressure are within standard limits.

General: The patient appears to be healthy and is not in severe distress.

HEENT: NA.

Neck: Lymphadenopathy and masses absent.

Chest: Clear.

Peripheral Vascular: no murmurs, rhythm and regular rate.

Abdomen: It appeared soft, non-tender, and non-distended.

Musculoskeletal: NA

Neurological: Intact cranial nerves and focal deficits were absent.

Skin: Examining the beard region shows many red papules and pustules, some of which have crusting. There is evidence of post-inflammatory hyperpigmentation in several locations.

Diagnostic Results: There were no diagnostic tests offered.

Assessment: Pseudofolliculitis barbae seems to be the most likely diagnosis based on the patient’s history, physical exam, and absence of any significant abnormalities. People with curly or coarse facial hair are more likely to develop PFB, an inflammatory illness caused by ingrown hairs. The irritation of the hair follicles from very frequent shaving may lead to papules, pustules, and even hyperpigmentation. PFB manifests as razor bumps, which become worse after shaving and improve as hair grows back.

Differential Diagnosis:

1. Folliculitis: Similar symptoms may result from a superficial bacterial infection of hair follicles, but PFB is more probable due to the absence of itching and persistent indications.
2. Discoid lupus erythematosus: Erythematous papules and plaques are a possible presentation, but the disease’s characteristic distribution design and lack of systemic symptoms make this a less probable diagnosis.
3. Tinea barbae: crusting, scaling, and a positive fungal culture typically indicate a fungal infection in the beard area, which is not present in this case.

Based on the patient’s symptoms and medical background, Pseudofolliculitis Barbae is the most likely diagnosis. (Shokeir et al., 2021). When hair is shaved or plucked, the sharp ends puncture the skin around them, triggering an inflammatory reaction. The curvature of the hair follicle facilitates this penetration, resulting in pruritus, post-inflammatory hyperpigmentation, papules, and pustules primarily in the beard region, though other depilated body areas can also be affected (Tshudy & Cho, 2021). Keloids have been observed to develop after PFB, leading to significant and unsightly scars. Similarly, shaving exacerbates the patient’s symptoms, while hair growth provides relief (Dalia et al., 2023).

 

 

 

 

 

 

 

 

 

 

 

References

Dalia, Y., Khatib, J., Odens Jr, H., & Patel, T. (2023). Review of treatments for pseudofolliculitis barbae. Clinical and Experimental Dermatology, 48(6), 591-598. https://doi.org/10.1093/ced/llad075

Shokeir, H., Samy, N., & Taymour, M. (2021). Pseudofolliculitis barbae treatment: Efficacy of topical eflornithine, long‐pulsed Nd‐YAG laser versus their combination. Journal of Cosmetic Dermatology, 20(11), 3517-3525. https://doi.org/10.1111/jocd.14027

Tshudy, M. T., & Cho, S. (2021). Pseudofolliculitis barbae in the US military, a review. Military Medicine, 186(1-2), e52-e57. https://doi.org/10.1093/milmed/usaa243