Mr. Kramer is a 78 year old recent widower. His wife just recently passed away and he felt an irritation under his right arm. When he got home, he noticed a rash. He relates this to sweating in a new suit jacket. He denies other new hygienic products and no new laundering agents. Since yesterday, he states the rash is beginning to spread.
PMedHx: DM 2 (1990)
PSurgHx: Left knee arthroscopy
Family Hx: Father, deceased: CAD
Mother, deceased: complications from Lupus
Brother, alive 74: HTN, Lupus
Soc Hx: Retired banker with 3 grown kids
Walks three times a week in a trail behind his house in a nature preserve; walks his dog on walking trails in woods
Never a smoker; rare social ETOH use; no illicit drugs
Watches carbs d/t DM
Meds: Metformin 500mg BID
Lisinopril 10mg QD
ASA 81mg QD
Atorvastatin 10mg QD (started on this 3 weeks ago)
General: feels fatigued, associates this to wife’s passing; denies fever or chills; hard to sleep d/t rash
Skin: rash under right arm; doesn’t itch a lot, but “burns”
Neck: supple; no lymphadenopathy
CV: RRR@78; normal S1 and S2; no mrg
Abd: soft, non tender
Skin: Vesicular rash on erythematous base; linear in appearance; about 8-10 lesions noted
#1 Based on this patient’s case, you believe he has what type of dermatology problem?
#2 What other subjective data would be important to inquire about in this patient?
#3 What diagnostics would you want to do on this patient?
#4 What would your treatment plan be for him?
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