Nursing homework help. MEDICAL MYSTERY FOR CHAPTER 12
HIS STORY
John was an operating room nurse. One day, he observed a skin rash on his elbow. The rash was itchy, but
he initially thought nothing about it. He applied some moisturizing cream, but 2 weeks later, he noticed
the rash was still present and appeared to be getting worse. When he looked at his elbow in a mirror, he
noticed that there was a large reddish patch on the surface of the elbow, and the rash appeared to have
some fine scales on it. He now thought he had perhaps acquired an infection from a patient, and he decided
to see his doctor.
John’s family practitioner prescribed him some Polysporin and told him it was probably just eczema. The
rash persisted, and John noticed that the skin had thickened and was turning silver-gray. He started to feel
some pain in the elbow joint but did not know if this was real or imaginary. He asked several other health
care professionals at work, and they all told him that he probably had contact dermatitis and it would get
better. John continued to apply all types of creams and lotions on the skin, but things only became worse.
John finally asked for a referral to a dermatologist.
THE EVALUATION
When I examined John in our dermatology clinic, I suspected that he had one of two skin disorders: eczema
or psoriasis. I asked John about his past history, drug use, family history, and history of allergies. All of
these were unremarkable except that John’s uncle had a similar skin problem on his knees years ago. That
was the clue I was looking for.
THE DIAGNOSIS
John had the classic signs of psoriasis. His rash was in a typical place, on the elbow, and the rash had
developed into a patch with silvery scales. These findings are seen in the majority of individuals with
psoriasis. John was worried that it might limit his career. I told him that the condition was treatable, but
that he would get flare-ups every now and then. John wanted to know if I was certain about the diagnosis
and asked about blood tests. I explained to him that the diagnosis of psoriasis is largely based on the patient
history and clinical features.
THE TREATMENT
Because John’s psoriasis was mild, I decided to treat him with topical medications. I told him to apply an
ointment that is a vitamin A derivative, or topical retinoid, and that he should keep his skin clean and dry.
In addition, I told him to avoid any sun exposure while he was applying the retinoid as these drugs can
make the skin extra sensitive to the sun.
CASE CLOSED
Psoriasis is a common skin disease that affects the life cycle of skin cells. As a result, cells build up rapidly,
forming thick, silvery scales and itchy, dry, red patches that are sometimes painful. When John returned
for his follow-up appointment, the red patch on his elbow had disappeared and the rash was nonexistent.
I asked him to read up on psoriasis so that he would understand why he should avoid stress and alcohol. I
warned John that this condition could flare up anytime, and that he will probably have to deal with it for
the rest of his life. I also mentioned to John that he might have some early symptoms of psoriatic arthritis,
which can cause pain, stiffness, and swelling in and around the joints.
Discussion Questions
1. What is psoriasis?
2. The lesions of psoriasis are referred to as plaques. Define plaque as used to describe a skin lesion.
3. At first, the doctor thought John might have eczema. Describe this condition. What is the difference between
eczema and psoriasis?
4. Some of his coworkers suggested that John might have developed contact dermatitis. How would you define
this condition? What are some causes of contact dermatitis? How is it different from exfoliative dermatitis?

Nursing homework help