NU 664B Week 11 Discussion 1: Atopic Dermatitis Differential Diagnosis: Atopic dermatitis

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Sample Answer for NU 664B Week 11 Discussion 1: Atopic Dermatitis

Differential Diagnosis:

Atopic dermatitis: Atopic dermatitis is the most likely diagnosis in this case. Atopic dermatitis is a chronic inflammatory skin condition which typically presents as a pruritic rash. Atopic dermatitis is most commonly seen in children which fits this patients demographics and the pruritus is a common feature of this condition. This patient has a family history that is significant for asthma, allergic rhinitis, and food allergies which is commonly seen in patients with atopic dermatitis and is the strongest risk factor for development of this condition which makes me highly suspicious that this rash is consistent with atopic dermatitis. This patient first developed these symptoms at the age of 4 which is consistent with a typical age of onset of atopic dermatitis at age 5 (Howe,2023).  Excessively hot or cold environments can trigger an exacerbation of atopic dermatitis so the fact that this patient often has flare ups in the winter and also had exacerbation after returning from a vacation in a tropical climate further supports the diagnosis of atopic dermatitis (Dunphy et al.,2019). The diagnosis is further supported by the affected body parts of the popliteal and antecubital fossae which is the most common presentation of atopic dermatitis in children (Dunphy et al.,2019). The presence of Dennie-morgan lines also supports the diagnosis of atopic dermatitis and is often seen in this condition (Garzon et al.,2020). Atopic dermatitis is typically diagnosed based upon clinical presentation and history alone and ruling out other skin conditions (Dunphy et al.,2019)

Impetigo: In this patient he may have two skin conditions present as separate issues. On exam he does have Impetigo “crust-like” lesions with serum oozing found on the left elbow (Dunphy et al.,2019). Impetigo is the most common bacterial skin condition that occurs in the pediatric population and presents as a superficial vesiculopustular infection that is highly contagious (Dunphy et al.,2019). This diagnosis would need to be included on the differential due to the description of the area and how common it is in the pediatric population and even more common in atopic dermatitis due to breaks in the skin from scratching. Impetigo typically presents with pruritus and is often found on the extremities which fits with this clinical picture (Dunphy et al.,2019). Often impetigo is diagnosed based on clinical presentation and history however, it can be confirmed by culture (Dunphy et al.,2019). Due to the highly contagious nature of impetigo the diagnosis would further be supported if someone else exposed to the patient had the same presentation, this is not present in the case but doesn’t rule out the condition (Dunphy et al.,2019).

Psoriasis: Another condition to consider as part of the differential diagnosis in this patient would be psoriasis. Psoriasis is a skin condition that will also present with erythematous, scaly plaques commonly on the extensor elbows and knees (Dunphy et al.,2019). The diagnosis of psoriasis should also be considered in this case because like atopic dermatitis it is also triggered by either an excessively cold environment or triggered by prolonged exposure to sunlight which is consistent with this case (Dunphy et al.,2019). This diagnosis is less likely in this patient because he fits less with the clinical picture of psoriasis which typically has an age of onset either in the late teens to early 20s or late 50s to early 60s (Dunphy et al.,2019). This patient was asked about joint pain because patients with psoriasis may also experience psoriatic arthritis where joints are affected and painful (Dunphy et al.,2019). In this case the patient has no joint pain. Often a diagnosis of psoriasis can be made based on clinical presentation and history alone. In this case the presentation, history, and demographic features of the patient are more consistent with atopic der