Patient Profile

• Name: Sarah L., 32-year-old female

• Occupation: Teacher

• Chief Complaint: “My skin rash keeps getting worse and is really itchy.”

• Onset: 2 weeks

• Past Medical History: Mild seasonal allergies, no chronic illnesses

• Medications: None

• Social History: Lives with two cats, recently moved into an older home; no recent travel

• Family History: Mother—eczema; father—type 2 diabetes

History of Present Illness

The patient reports a progressively worsening itchy rash on the palms, elbows, and behind the knees. Initially mild, the rash is now erythematous, dry, and starting to crack. She notes increased itching at night.

Denies new soaps or detergents, but admits to using a new scented body lotion. Stress levels have been high due to work.

Physical Examination

• Vitals:

o Temp 98.4°F

o HR 78 bpm

o BP 118/72 mmHg

o RR 14

• Skin Exam:

o Erythematous plaques with silver-white scale on elbows

o Lichenification in popliteal and antecubital fossae

o Small fissures on palmar surfaces

o No drainage, no signs of infection

• Nails:

o Mild pitting on fingernails

• Other Systems: Normal

Sample Lab Studies

Note: Skin disorders are often clinical diagnoses, but labs help rule out infection/allergy or support alternatives.

CBC

Test Result Normal Range

WBC 7.0 x10³/µL 4.5–11

Hemoglobin 13.4 g/dL 12–16

Platelets 280 x10³/µL 150–400

Eosinophils 7% (high) 0–5

ESR

Test Result Normal

ESR 18 mm/hr 0–20 mm/hr

CRP

Test Result Normal

CRP 0.9 mg/dL <1

IgE Level

Test Result Normal

IgE 250 IU/mL 0–100 IU/mL

Skin Scraping (KOH prep)

• Negative for hyphae

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