1. What essential question does one still need to ask in order to help make the diagnosis?
2. What is the tentative diagnosis?
3. Can you list at least three differential diagnoses?
4. What features of this condition differentiate it from other conditions in your differential diagnosis?
5. What is the suitable treatment for this condition?
Treating A Patient With Multiple, Pruritic Open Lesions On Both Feet
A 32-year-old female presents to the clinic with a chief complaint of multiple pruritic lesions on the tops of both feet. The lesions have been present for several months and appear to be increasing in number and size. The patient has not seen any other physician for this problem and she has not been putting any medications on the condition. The patient reports the lesions start as very small red bumps and itch a great deal. After scratching the bumps, she says the lesions get bigger and new itchy bumps occur around the area in a few days or so. The condition is so bad at this time that she cannot wear closed shoes, go to work or take care of her family. After further questioning, the patient stated that prior to the current skin condition, she had no known exposure to any chemicals, paints, toxins, irritants or other potential allergens. She also notes she is not taking any medication, vitamins or supplements. The patient also has no known allergies to any medications or environmental agents. No one else in her household or within her family has any similar skin conditions.
What Does The Physical Examination Reveal?
The physical examination revealed a large number of scratches, excoriations and open areas with surrounding erythema on the dorsum of both feet. Some of the lesions appeared new and some looked much older. There were no primary lesions anywhere else on the feet or lower legs. There were no other rashes, skin changes or edema. At the time of the visit, the lesions were symptomatic and the patient was reporting pruritus as the main complaint. A careful examination found no other similar appearing lesions on the upper extremities, torso, head and neck region. There were no other obvious dermatological findings other than the ones noted on the initial examination. There were no other positive findings during the rest of the physical examination.