Assignment
J.K. is a 42 year-old male who presents to the clinic with a 3-week history of erythematous lesions on the lower anterior, medial, and lateral aspects of both legs that he states developed slowly and has persisted. He tried an OTC neomycin ointment, which caused the lesions to worsen; he stopped using it and the lesions improved slightly. Over the past 5 days, the leg lesions have become tender with a small amount of straw-colored, odorless drainage, and he is experiencing moderate to severe pruritis in his legs and in other areas on his arms and back. Mr. K. has a 14-year history of generalized pruritis, and has experienced similar recurrent episodes of localized, intensely pruritic lesions of his lower extremities in the past. Allergy patch testing was performed "in the past", and according to the patient, was negative. Mr. K. denies chemical exposure at work, within and outside his home, and he has not recently traveled or been exposed to someone with a similar problem. He states he is mildly intolerant to sunlight. Mr. K. has a positive family history of allergies, eczema, heart disease and diabetes. Both parents are alive and well; his mother is sensitive to cosmetics and sunscreens, and suffered from eczematous rashes as a child. Mr. K. does not smoke or drink and is employed as a social worker. He lives in a single-family home with his wife and 2 pre-school age children. Currently, 1 dog, 6 puppies and 1 cat also reside in the home.
A. What additional questions would you ask Mr. K., and why? List a minimum of 5 questions and provide rationale for each question (why do you want to know this information?)
B. What initial steps would you take in preparation to begin assessing Mr. K. and why?
C. Upon inspection of Mr. K.'s lower legs, you observe the following (see image)
D. What are characteristics of macules, papules, and plaques? Describe each separately.
E. Why might Neosporin ointment have made Mr. K.s lesions worse?
F. What would you include on your list of differential diagnoses, and why?