Case Study 1- Skin Disorder

Case Study 1- Skin Disorder

 The provided case study describes a 46-year-old man arriving at the clinic with a case of a pruritic skin rash. The rash has been present for some weeks. Initially, the rash began on his chest then spread to his arms and back. The patient denies any new detergents, foods, or medications.  He has no known allergies and only takes Ibuprofen for knee pain.  The patient recently returned from a trip to Florida.  Examination of the patient reveals flat, circular, light-colored patches to his chest, back, and arms.

Diagnosis

With the given information, the diagnosis could potentially be tinea versicolor.  Lesions of tinea versicolor are often white or light pink.  Most are round or oval appearing commonly on the patient’s chest, abdomen, or back.  Tinea versicolor is more prevalent in the summer with heat and humidity (Buttaro, Trybulski, Polgar, Bailey, & Sandberg- Cook, 2017).  The diagnosis was made based on the fact that the patient recently went to Florida, where heat and humidity are prevalent.  The description of the patient’s rash also aided in this diagnosis.  Tinea versicolor often presents as a gradual rash.  Some patients may complain of the rash itching due to the yeast that causes the rash (Nevas, 2012).   Tinea versicolor should be confirmed due to other skin conditions being closely related to it.  Some of these other skin conditions include vitiligo, and pityriasis alba (Hudson, Carroll, & Kim, 2017).

  Patients should be educated that the flare-ups of this disease are frequent.  Patients should be taught that these flare-ups mainly occur during summer months (Buttaro, Trybulski, Polgar, Bailey, & Sandberg-Cook, 2017).

 

 

Treatment

Many treatment options are available for patients that are affected by tinea versicolor (Nevas, 2012).  Antifungal creams such as imidazoles are first-line treatment choices.  These creams can be applied during active infections.  Oral antifungal medications and topical shampoos containing selenium sulfide or pyrithione zinc can also help with this diagnosis (Buttaro, Trybulski, Polgar, Bailey, & Sandberg-Cook, 2017).   Tinea versicolor, if untreated, can lead to folliculitis, which requires more aggressive treatment (Hudson, Carroll, & Kim, 2017).  Ketoconazole is one of the most prescribed creams for tinea versicolor.  This cream is applied to affected areas for 5 minutes before being washed off.  It is a once-daily application for up to four weeks (Nevas, 2012).  Oral medications should be used if there is extensive skin involvement or if topical medications fail to help the patient.  Ketoconazole can be given as a daily dose of 200mg PO for ten days.  However, oral antifungals can cause damage to the liver.  Patients should be aware of the side effects (Nevas, 2012).  For potential flare-ups, patients can use selenium sulfide shampoo for 10 minutes each day for a week to prevent reoccurrences (Buttaro, Trybulski, Polgar, Bailey, & Sandberg-Cook, 2017).

Conclusion

Tinea versicolor is a common, non-life-threatening condition (Buttaro, Trybulski, Polgar, Bailey, & Sandberg-Cook, 2017).  With the given scenario, the patient was determined to be afflicted with this condition due to his exposure to heat and humidity, and the description of his rash.  Tinea versicolor often occurs in summer months, with circular hypopigmented lesions on the back, chest, and upper arms (Hudson, Carroll, & Kim, 2017).