During a health examination, it is crucial for advanced practitioners to carefully assess the patient’s skin as part of the review of systems. The skin often goes unnoticed, but even a small undiagnosed blemish can significantly impact a patient’s quality of life. Skin disorders and diseases can exhibit similar symptoms, necessitating the establishment of differential diagnoses to determine the accurate diagnosis. As the largest external organ of the human body, maintaining the health of the skin is paramount for advanced practitioners.
Chief Complaint: Multiple red spots across the torso (Image #2)
History of Present Illness (HPI): A 46-year-old Caucasian male presents to the clinic with approximately 40-50 red spots across the torso. Some spots are raised, while others are flat with distinct edges. The onset of the spots is unknown. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions
Skin: Multiple small red round macules and papules, measuring from pinpoint to a few millimetres, distributed randomly across the torso.
Based on the presented data, the potential diagnosis is cherry angiomas. However, several differential diagnoses need to be considered, including capillary hemangioma, melanoma, miliaria rubra, angiokeratoma corporis diffusum, and Kaposi sarcoma. Cherry angiomas, the most common type of acquired benign vascular proliferation, typically present as non blanching red papules on the trunk in approximately 50% of adults (Darjani et al., 2018). While usually asymptomatic, patients may be concerned about the cosmetic aspects and potential malignancy risk. Miliaria rubra, caused by the obstruction of sweat glands and extravasation of sweat into the dermis, manifests as tiny erythematous papules on reddened skin (Mohanan et al., 2014). Capillary hemangiomas, characterised by the abnormal overgrowth of tiny blood vessels, are commonly observed in infants and children but can also occur in adults. These hemangiomas are asymptomatic and typically resolve without intervention. Melanoma, a form of skin cancer, occurs when melanocytes grow uncontrollably (What Is Melanoma Skin Cancer?, 2019).
NURS 6512 Week 4 Differential Diagnosis for Skin Conditions
It primarily affects the back and torso of men and can be highly dangerous due to its potential to metastasize. Angiokeratoma corporis diffusum, also known as Fabry disease, is a rare genetic disorder resulting from an enzyme deficiency. It leads to the progressive accumulation of glycosphingolipids in endothelial and vascular smooth muscle cells (Barac et al., 2018). Cutaneous angiokeratomas, typically dark red to black in colour, are a common manifestation of this disease but are usually asymptomatic. Kaposi sarcoma, associated with human immunodeficiency virus (HIV) infection, presents as red or purple patches of abnormal tissue beneath the skin (Ball et al., 2019).
To provide high-quality healthcare and maintain the patient’s quality of life, advanced practitioners must conduct a thorough assessment that includes the skin. Although skin disorders and diseases can be overlooked, the practitioner should remain vigilant and establish differential diagnoses to identify the specific condition accurately. In addition to careful assessment and health interviewing, laboratory work and biopsies may be necessary. However, without a comprehensive skin assessment, these steps may prove futile. NURS 6512 Week 4 Differential Diagnosis for Skin Conditions
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Barac, I. S., Tomesc, D. F., Stan, A., Vacaras, V., & Muresanu, F. D. (2018). Fabry Disease. Romanian Journal of Neurology, 17(4), 200–203.
Darjani, A., Rafiei, R., Shafaei, S., Rafiei, E., Eftekhari, H., Alizade, N., … Najirad, S. (2018). Evaluation of Lipid Profile in Patients with Cherry Angioma: A Case-Control Study in Guilan, Iran. Dermatology Research & Practice, 1–5.
Mohanan, S., Behera, B., Chandrashekar, L., Kar, R., & Thappa, D. M. (2014). Bull’s-eye pattern in miliaria rubra. The Australasian Journal Of Dermatology, 55(4), 263–265.
What Is Melanoma Skin Cancer?: What Is Melanoma? (2019, August 14). Retrieved from https://www.cancer.org/cancer/melanoma-skin-cancer/about/what-is-melanoma.html