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