A 20-year-old young man new to the Clinic seen by Dr. Laurie Tolman.
CHIEF COMPLAINT: Skin rash.
HISTORY OF PRESENT ILLNESS: He dates this back a week, perhaps two weeks, when he began to develop lesions on his arms, his neck, his trunk. He says there is nothing below the waist. Although it looks rather inflammatory-looking,he says it is completely asymptomatic. No itch. No burn.
No nothing. He is continuing to get some new lesions.
PAST MEDICAL HISTORY: He has never had anything like this before.
MEDICATIONS: Currently he is on no medications.
ALLERGIES: He has no known allergies to medications.
REVIEW OF SYSTEMS: Complete review of systems is negativeto questioning.
FAMILY HISTORY: Negative.
SOCIAL HISTORY: No significant professional exposured. His sun exposure is moderate. He wears a sunscreen when he is out. Pain assessment is negative today.
PHYSICAL EXAMINATION: He is ........ and does not appear to be in any acute distress. He seems oriented as to person, time, and place. His mood, affect, and grooming appear normal to me.
Examination included the head area, which included scalp,ears, nose, lips, tongue, oral mucous membranes, eyebrows, eyelashes, eyelids, and conjunctivae, the rest of the face, the neck, the trunk anterior and posterior, and the upper and lower extremities bilaterally.
PERTINENT FINDINGS: No nodes were palpable in the neck,supraclavicular, or axillary areas. On his neck, on his extremities and on his trunk, he had erythematous papularlesions. On his trunk and the flank areas, they seemed to follow the skin lines. They were rather uniform in appearance, pink, measuring 0.2 to 0.4 cm. Some of them had a central crusted area. Most of them around his neck had had a crusted appearance.
IMPRESSION: Could this be PLEVA (pityriasis lichenoides et varioliformis acuta) or even an inflammatory pityriasis rosea (there was no evidence of a primary lesion for this disease, however).
PLAN: After discussion of a possible diagnosis with the patient a biopsy was performed.