SUBJECTIVE: The patient is a (XX)-year-old gentleman with a history of actinic keratoses and hand eczema who returns, one year after his last visit, complaining of a one-month history of slightly itchy patches on his shoulders and legs. The patient has never had this type of rash before. He did use the triamcinolone acetonide 0.1% ointment that he has for his hands. He only used it for a couple of days. He reports it did not have any effect. No other concerns regarding his skin today. The patient’s past medical history is significant for actinic keratosis, negative for skin cancer. The patient is on atenolol, amlodipine, Rhinocort, triamcinolone acetonide 0.1% ointment b.i.d. p.r.n. hand eczema. Review of systems is negative. The patient’s family history is negative for melanoma. The patient is retired, and he does not spend much time outdoors. He does wear sunblock for outdoor activities.
OBJECTIVE: The patient is alert and oriented x3 with normal mood and normal body habitus. The patient’s frontal scalp, face, neck, chest, abdomen, back, upper and lower extremities, hands, feet bilaterally were examined, and there were 2-4 mm pink, rough, keratotic macules on the frontal scalp, on the right and left upper malar area, and on the right distal dorsal arm. The rash was localized to the shoulders, upper back, and proximal legs. They were 1 to 2.5 cm, pink, very slightly scaly plaques. There was mild erythema with slight scale on the palmar surface of both hands and the fingertips show mild fissuring.
ASSESSMENT:
1. Chronic hand eczema.
2. Nummular eczema on the shoulders and legs.
3. Actinic keratoses on the scalp, cheeks, and arms.
PLAN:
1. Liquid nitrogen 10-second freeze for destruction of nine actinic keratoses.
2. Elocon ointment b.i.d. to the nummular eczema. Discussed beginning regular use of moisturizer to all of his skin. If the rash does not respond in the next 2 to 3 weeks, we asked him to call back.
3. The patient will continue with the triamcinolone acetonide 0.1% ointment b.i.d. for the hand eczema, which he has found helpful.
4. Follow up again in one year.
