CHIEF COMPLAINT: Rash on the left arm.
HISTORY OF PRESENT ILLNESS: The patient is a (XX)-year-old Hispanic woman with a one-week history of rash. It started after doing yard work, mainly on her bilateral forearms and antecubital fossa, one small patch on her face. It initially spread over the first two days. It has been persistent, itchy, and she has noted crusting on it. She felt that it could be poison ivy. She has attempted calamine. It is still persistent and itchy, not particularly improved, so she presents for further evaluation.
PAST MEDICAL HISTORY: Diabetes, ovarian cancer, chronic renal insufficiency, anemia, neuropathy, DVTs, and hysterectomy.
MEDICATIONS: Zoloft, stool softener, multivitamin, metformin, ibuprofen, calamine, and over-the-counter cortisone cream.
SOCIAL HISTORY: Recent yard work preceding rash.
FAMILY HISTORY: Not elicited.
REVIEW OF SYSTEMS: Per HPI.
PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature 97.8, blood pressure 134/74, heart rate 68, respiratory rate 18, and O2 saturation 97%.
GENERAL: The patient is a well-nourished, well-developed individual sitting quietly in her bed.
HEENT: Sclerae are anicteric. Conjunctivae are well perfused. Mouth reveals no intraoral lesions.
SKIN: Demonstrates a confluent patchy rash with some weeping and also excoriations up to 4 cm in diameter. Patchy distribution, bilateral forearms and a 1 cm patch on her right upper lip. The appearance is consistent with rhus dermatitis.
EMERGENCY DEPARTMENT COURSE: The patient presents to the emergency department with bilateral forearm rash, facial rash. Appearance is consistent with a contact dermatitis secondary to poison ivy. We had considered systemic steroids; however, she is diabetic. Therefore, we will start her on a higher potency steroid cream to be applied topically. We have recommended that she apply it only to her arms and not her face.
FINAL IMPRESSION: Rhus dermatitis.
PLAN:
1. Prescription for Atarax and Kenalog cream 0.1%.
2. Poison ivy instructions.
3. Return for any other questions or concerns.
