CHIEF COMPLAINT: Rash.
HISTORY OF PRESENT ILLNESS: This is a (XX)-year-old woman with no known medical problems who comes in today with a rash on her right arm and back for the past 5 to 6 months. She states that the rash, which is papular in form, began on her right forearm and has now spread to her back and her right groin. She says that she has been to her primary care physician multiple times to have this rash evaluated and did have workups for syphilis, gonorrhea, chlamydia and herpes, all of which came back negative. The physician has appropriately prescribed her hydrocortisone cream for management and it has not relieved her pruritus. She comes here for further evaluation and possible dermatologic referral.
PAST MEDICAL HISTORY: None.
PAST SURGICAL HISTORY: Bilateral wrist surgery after crush injury 2 years prior.
ALLERGIES: NKDA.
MEDICATIONS: Neurontin, Vicodin, oxycodone, and hydrocortisone.
SOCIAL HISTORY: The patient smokes 5 cigarettes a day. Drinks no alcohol and does no drugs.
REVIEW OF SYSTEMS: Positive for papular rash on right forearm, back and right groin. Positive for pruritus. Negative for shortness of breath, visual changes, oral or throat constriction. Negative for known allergy or history of dermatitis. All other systems are negative.
PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 122/78, pulse 78, respiratory rate 18, temperature 98.8, and O2 sat 99% on room air.
SKIN: The patient has multiple 2 to 3 mm papular eruptions on her right forearm, some of which are obviously new and some of which have scarred over. She also has approximately 5 to 10 of these on her back and 2 of them on her right groin to the right of her labia. None of these papular eruptions are currently open or weeping any pus, and there is no other associated dermatitis around them. There is no associated lymphadenopathy.
EMERGENCY DEPARTMENT COURSE: The patient was seen and evaluated by myself and the attending. Given the fact that this patient has been seen and evaluated by her primary care physician multiple times and has already been tested for syphilis, gonorrhea, chlamydia and herpes, we do not feel that sending off these titers would be appropriate at this time. She does not have any uniform distribution of this rash. It is not bilateral. It does not seem to be associated with any clothing or soaps or other inciting factors that may be causing dermatitis, and we do not have an obvious source for this rash. However, this does not seem to be an emergent condition at this time.
She is not having any systemic manifestations. She does not have any other illnesses and is completely normal via vital signs and focused physical exam. We believe that she can be discharged home. She will follow up with her primary care physician, and we are also faxing over a referral to dermatology clinic so they can see her and possibly, if they feel it necessary, biopsy this rash. She will continue to take the hydrocortisone cream, and we have asked that she also start taking Benadryl p.r.n. for the pruritus that she may be experiencing despite the cream.
DIAGNOSIS: Rash.
CONDITION: Stable.
DISPOSITION: Home.
PLAN:
1. Follow up with dermatology clinic.
2. Follow up with primary care physician as needed.
