Diagnosis/Diagnoses: â€œEczemaâ€ with â€œseborrheic dermatitisâ€ (Cleveland Clinic, 2020). The ICD-10 code is L21.9 (ICD10data, n.d.b). The patient has been diagnosed eczema. This is evident by the patient having symptoms of a rash on both arms, itching, and flakiness on her scalp. She has a family history of eczema, with her biological brother. The pain she has with the itching is 7/10 with a burning sensation followed by severe itching. The new onset started in October. Winter months increase dryness and eczema can be more prominent during this time (Dall’Oglio et al., 2022). The cream she uses is hydrocortisone 2.5%, which is worsening her symptoms. The patient may have â€œpsoriasisâ€ as well. The ICD-10 code is L40.0 (ICD10data, n.d.a). Eczema and psoriasis are the two most prevalent skin conditions. Eczema is characterized by red, itchy, and inflamed skin. This is generally caused by genetics and environmental factors. Treatment measures are topical creams and oral medications. Psoriasis is an autoimmune disease that also has red, scaly patches that are itchy and painful. The immune system attacks healthy skin cells. The cause is the same as eczema, genetic and environmental factors. The treatment options are topical creams, oral medications, and light therapy (Hammad et al., 2023). The pertinent positives for these diagnoses are that both eczema and psoriasis have similar findings in their presentation. The pertinent negatives of both diagnoses is that the patient does not have red patches which are part of the defining characteristics of both eczema and psoriasis.
The plan is to use therapeutics to help alleviate the symptoms as the conditions are not curable. For eczema, PD4 and JAK inhibitors have been found to be most useful (American Academy of Dermatology, 2023).
Diagnostics: Allergy skin panel to look for possible irritants that increase and provoke the symptoms.
Therapeutic: Tofacitinib 2% bid. This has been proven to have superior efficacy among patients with eczema (Zhang et al., 2021). NB-UVB treatment three times a week. This has been proven to show significant efficacy amongst patients with psoriasis (Elmets et al., 2019).
Educational: Tofacitinib cream should be discontinued if symptoms worsen or a rash appears (Zang et al., 2021). NB-UVB treatments may cause a rash after treatment. A sunburn may develop. Some pigmentation may be increased in areas of treatment. In long-term treatment, if the patient has received over 500 treatments, the patient would need to be evaluated for skin cancer (Purokayastha et al., 2023).
Consultation/Collaboration: Referral to an Allergic/Immunologist and a Dermatologist for continued testing and diagnosis.