CHIEF COMPLAINT: Rash.
HISTORY OF PRESENT ILLNESS: The patient states that he has had this for several weeks. He also has a large abscess on his neck. He gets his hands dirty on a daily basis as a consequence of his work at a construction site. He has had little skin infections in the past. He states that he also has a history of psoriasis that is well controlled at this time.
PAST MEDICAL HISTORY: Depression and skin infections.
MEDICATIONS: None.
ALLERGIES: None.
SOCIAL HISTORY: The patient smokes a pack of cigarettes a day. No alcohol or illicit drug use.
FAMILY HISTORY: Noncontributory.
REVIEW OF SYSTEMS: As mentioned, otherwise negative.
PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 124/74, pulse 78, respirations 18, and temperature 97.8.
GENERAL: The patient is awake, alert, and oriented, in no acute distress.
HEENT: Normocephalic and atraumatic. Pupils are equal, round, and reactive to light and accommodation. Extraocular movements are intact.
CHEST: Good breath sounds bilaterally with no wheezes, rales or rhonchi.
HEART: Regular rate and rhythm with no murmurs, rubs or gallops.
ABDOMEN: Soft, nontender, and nondistended. Good bowel sounds with no organomegaly.
EXTREMITIES: No clubbing, cyanosis or edema.
SKIN: The patient has what appears to be folliculitis to the dorsal surfaces of both hands, nothing on the palmar surface. They seem to be excoriated from scratching. He has a 3 x 3 cm abscess on the back of his neck. There is no surrounding cellulitis.
EMERGENCY DEPARTMENT COURSE: This patient was seen and evaluated for rash and abscess.
PROCEDURE NOTE: The abscess was anesthetized using 1% lidocaine and 1% epinephrine. After adequate anesthesia, we incised the abscess using an 11 blade scalpel. This did remove quite a bit of purulent drainage. We then broke up the loculations with blunt forceps. He tolerated this procedure fine. We placed some Polysporin ointment and bandaged it. The patient was given discharge instructions.
DISCHARGE DIAGNOSES:
1. Folliculitis.
2. Abscess, status post incision and drainage.
PLAN:
1. Will use Bactroban cream to the hands twice daily.
2. He needs to try to maintain better hygiene with his hands.
3. He needs to wear gloves at work if he is constantly around dirt and cement.
4. He is to return in two days for wound recheck and packing removal.
DISPOSITION: The patient is discharged to home in stable condition.
