Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions

NURS 6512 Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions

Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions

This SOAP note describes various skin condition presentations, focusing on a particular example given. It uses medical terminologies to describe the skin condition given and provide a probable diagnosis based on the appearance (Bnedetti, 2019). The SOAP note will also suggest differential diagnoses for the same skin condition, which can be eliminated based on the clinical presentations of the condition to reach the definitive diagnosis.

Skin Condition 3

Skin Comprehensive SOAP Note Template


Chief Complaint (CC): “There’s this painful itchy rash on my beard for 3 weeks now”

History of Present Illness (HPI): MA is a 34-year-old Hispanic male who presents to the ER with a complaint of

an itchy painful rash for three weeks. The rash started after he had come back from a work retreat where they shared a room with some colleagues.  He says the onset was gradual and started as an itchy on his chin that he could not resist scratching. This later progressed to the rash, which was painful especially on scratching it. He reports that scratching partially relieves the itch but exacerbates the pain. It is associated with small purulent blisters and partial hair loss on the affected areas. He reports use of baby powder on the blisters and OTC Tylenol tablet, which helped with the pain.

Medications: He has been using 500mg  Tylenol tablet po TDS.

Allergies: Allergic to red meat -gives him rash and swelling

Past Medical History (PMH): Past hospital admission at age 12 after tonsillectomy, no history of blood transfusions.

Past Surgical History (PSH): Tonsillectomy at age 12 years

Sexual/Reproductive History: Heterosexual male, has been married for 6 years with one child.

Personal/Social History: He is married and they have one child. He is a lawyer by profession with his own practice. They live in a three bedroomed apartment and go to church every Sunday. He admits occasional cigarette smoking about I pack a week and is a social drinker.

Health Maintenance: Exercises by running every morning. Attends dental appointments every 2 years

Immunization History: He reports having received all this childhood vaccinations as recommended, and takes the seasonal flu shot.

He has received COVID-19 vaccines, all doses as recommended.

Significant Family History: Positive family history of hypertension (father)


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General: Reports no hotness of body, general body malaise. No recent changes in appetite or weight

HEENT: He reports no headaches, no dizziness, no changes in vision, no tinnitus, no sore throat, no bleeding gums, no difficulty or painful swallowing, no ear discharges, no blood

Respiratory: No shortness of breath or difficulty breathing, no wheezing and no cough, No chest pains

Cardiovascular/Peripheral Vascular: No palpitations, No dyspnea, No shortness of breath on exertion

Gastrointestinal: No passage of loose stools, No constipation or abdominal pains. No nausea and vomiting

Genitourinary: No urinary urgency, no dysuria, no hematuria, no painful urination

Musculoskeletal: He denies pain or swelling in joints and muscles in both lower and upper extremities

Neurological: Denies headaches, dizziness, loss of consciousness, or memory loss. No abnormal body movements, no vision loss, no hearing problems

Psychiatric: Denies auditory or visual hallucinations. No suicidal thoughts

Skin/hair/nails: Patient complains of a big-blistered rash on his left beard. The rash is painful and oozes a clear foul-less fluid. He also reports hair loss in patches on the affected area.

He reports no change on the nails such as abnormal discoloration. He reports no other skin changes in any parts of the body.





Physical Exam:


Vital signs: Temperature 98.6 (37C), PR 98 beats/min, RR 20 breaths/min and strong, O2 Sat 100% on room air, BP 125/78 mmHg

General: Patient is A & O, in fair general condition. Not in obvious respiratory distress or pain, well-groomed and dressed appropriately according to the weather

HEENT: Head is normal size, no masses, no lesions, no scars, good hair distribution throughout scalp, no rashes, and no tenderness on palpation. Red rash on chin, with patches of hair loss and pruritic areas. Tonsils absent, good oral hygiene, no thrush, no halitosis

Neck: No tracheal deviation, No masses, no lumps or edema. No lymphadenopathy and No distended neck veins

Chest/Lungs: On inspection, the chest rises symmetrically with respiration, no masses, no lesions, no gynecomastia. No surgical/traumatic scars. Chest is resonant to percussion throughout. Normal vesicular breath sounds heard on auscultation, no added breath sounds

Heart/Peripheral Vascular: Apex beat felt on palpation, S1 and S2 heard. No murmurs, rubs or gallops. No finger clubbing, no Osler’s nodes, no splinter hemorrhages, no cyanosis

Abdomen: Abdomen is of normal fullness, no distension and moves with respiration. No lesions, No obvious swelling. No therapeutic or surgical scars. Umbilicus is inverted. No tenderness on light palpation. On deep palpation, no masses, no organomegaly. Normal bowel sounds present on all 4 quadrants, no bruits

Genital/Rectal: The patient reports that he does not have any issues with the genital. He refused thorough examination because of privacy.

Musculoskeletal: No edema/swelling in upper and lower extremities.  He can differentiate sharp, light, and dull touch on both extremities. Normal color of nails for race and ethnicity.   Symmetrical muscle development in upper and lower extremities. Good muscle tone and strength. Good motion range in all joints. Absence of crepitus, inflammation, edema and tenderness. Muscle strength is 5/5 in all groups

Neurological: A&O x4 in time, place and person. He is able to follow and understand simple and complex commands. Good recent and remote memory. Cranial nerves II -XII grossly intact. Deep tendon reflexes intact.  Able to differentiate soft, hard, blunt and sharp sensation on upper and lower extremities. He can also distinguish hot and cold temperatures

Skin: There is a notable red rash on the beard, partial hair loss noted on the affected area. Red pruritus blisters seen. No other areas of the skin affected. Good hair distribution on the head.


Diagnostic results:

Direct microscopic examination or,

Cultures – to identify micro-organism (Vazheva & Zisova, 2021).

Potassium hydroxide wet mount of plucked hairs/ scales




Tinea barbae (Bnedetti, 2019)

This is the most likely diagnosis for the patient based on the location and distribution of the rash on the beard only. The rash usually forms a solitary patch that is circular, with raised scaly edges. It has ring-shaped central hypopigmentation (Bnedetti, 2019). The border can be popular and itch is always common. This is typical with the patient description.

DDx: Based on the characteristics of the skin lesion, the other differential diagnoses most likely could be as follows; (Bnedetti, 2019).

  1. Allergic contact dermatitis
  2. Bacterial folliculitis
  3. Pseudofolliculitis barbae
  4. Acne vulgaris
  5. Cutaneous candidiasis



PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.


Bnedetti J. (2019). Description of Skin Lesions. MSD MANUAL Professional Version

Vazheva, G., & Zisova, L. (2021). Tinea barbae profunda caused by trichophyton rubrum – an autoinoculation from a primary tinea pedis. Folia Medica63(2), 292-296.

SUBJECTIVE DATA: “I have indented reddened streaks on my skin that started appearing on the second month when I became pregnant.” “Too many stretch marks on my stomach since being pregnant”


Chief Complaint (CC): Picture #2- I have a concern with the stretch marks on my stomach which first noticed at the end of my first trimester in pregnancy.


History of Present Illness (HPI): Ms Caroline Fisher is a 32 year old female is a gravida 1, para 0 Black American who is pregnant and in her 24 weeks gestational period who came today and complained about the changes she has been noticing on her abdomen that is characterized by streaks of reddened skin which continued to darken as the pregnancy progresses, last menstrual period was 9/21/21. Ms Caroline stated that the stretchmarks are more prominent on the anterior abdominal while few lines run towards the back. Ms Caroline at this time stated that sometimes she feels itchy but denies any pain or any discomfort. Ms Caroline stated that her friends introduced her to an herbal therapy known as cocoa butter which she has been apply but no obvious changes. Ms Caroline is so much concerned about the recent changes to her body and skin and doesn’t feel good about her recent look, Ms Caroline has a believe that she has actually put on weight and that might have worsened the stretchmarks.


Patient is on the following medications;

Pregnacare which contains mostly vitamins

400 μg of folic acid prescribed once daily

Iron 600mg Daily

Metformin 500mg twice daily for diabetes

Norvasc 10mg daily for hypertension


Allergies: Allergic to Sulphur medications. No known food allergies.


Past Medical History (PMH): Ms Craoline is a known Type 2 diabetic patient, was last hospitalized in 2020 prior to her recent pregnancy on account of uncontrolled hyperglycemia which was managed and well controlled during the 2 days’ hospitalization before being discharged, patient also has history of borderline hypertension.


Past Surgical History (PSH):  Patient denies any surgical history.


Sexual/Reproductive History: Ms. Caroline is Straight and is sexually active. No positive history of sexual abuse, has had 2 partners since she became sexually active. Menarche started at the age of 12 and since then have always had a regular menstrual cycle of 28days.


Personal/Social History:  Ms Caroline is an elementary school teacher and lives with the boyfriend in a single family house. Denied history of illegal drug use, drinks alcool occasionally but stopped since she got pregnant.


Health Maintenance: Ms Caroline has been compliant with her regular pregnancy checkup and consults as advised.


Immunization History: Mrs Coroline is upto date with her vaccinations including covid vaccine and the last immunization was the flu shot which she got on 1/3/22


Significant Family History:  Father has history of Diabetes which is well controlled with insulin and Mother had hypertension before her death at the age of 60 years in 2021 due to complication of coronavirus.


Review of Systems:


General: Ms Caroline is in a stable condition, no obvious distress noted. She just doesn’t feel good about the recent skin changes since she got pregnancy as that is her first pregnancy.

HEENT: Ms. Caroline denies having any problems with hearing, vision, nasal congestions, nil swelling and no remarkable change on the throat.

            Respiratory: Ms Caroline denies any breathing problems

Cardiovascular/Peripheral Vascular: Ms Caroline denies any episodes of irregular heartbeats, denies any heart murmur and not chest pain.

Gastrointestinal: Patient denies any problems with appetite. Confirmed she has regular bowel movements. Patient is positive for constipation occasionally.

            Genitourinary: Patient denies any history of urinary tract infection.

            Musculoskeletal: Patient is positive mild back pain which she takes   regular        Tylenol 375mg orally every 8 hrs. when needed.

Neurological: Patient is alert and oriented, no neurological deficit noted. Denies any history of epilepsy or seizures.

            Psychiatric: Patient denies any history of mental health illness.

            Skin/hair/nails: Ms Caroline is very much concerned about the new stretch

marks that runs through her abdominal wall. Patient does not have any other skin alteration. Patient complained of hair dandruff.





Physical Exam:

Vital signs: Patients blood pressure measured on the right arm was 144/81, Temperature is 97.7 degree Fahrenheit, Pulse is 72bpm, Respiration is 17c/m, Weight is 179 pounds, height is 5 feet 6 inches and a calculated BMI of 28.9.

General: Ms. Caroline came in alert and oriented to time and place. The vital signs showed that the patient is overweight with a BMI of 28.9 and blood pressure is elevated.

HEENT: On examination of the hair, there were presence of dandruff on the scalp.No inflammation noted on the tonsil and no tenderness noted at the temporomandibular joint. The pupils were equal, round, reactive to light. No discharges noted from ears.

Neck: There was normal range of motion, and no distended juggler vein noted.

Chest/Lungs: The trunk was clear. The intercostal movements were abnormal breath sounds like wheezes. Respiration rate of 18 b/min.

Heart/Peripheral Vascular: On auscultation, the S1 and S2 heart sounds were present and heart rate was within normal limits of 72bpm.

Abdomen: There was positive fetal heart rate of about 128b/m and thee were marked indented streaks on the abdominal wall.

Genital/Rectal: The vagina was free from any signs of infection, nil swelling, discharge or inflammation noted during assessment of the genitalia.

Musculoskeletal: There are no muscle or joint pains noted and there is full range of motion with no limitation.

Neurological: Mrs Caroline is oriented to time, place and person. Patient scored high on assessment of mental status. The mental assessment shows patient has memory intact both recent and past events.

Skin: Patients skin is warm to touch with a temperature of 97.8, nil discoloration noted except the indented stretch marks on the abdominal wall


Diagnostic results:

  1. There was Lab draw for White blood count which was unremarkable for infection
  2. On observation of the skin, the streaks and discoloration of the skin were present
  3. A culture of the skin is important to rule other causes of skin infections.
  4. Scraping of the nail and skin is key to rule out infections of the skin (Colyar,2015).




Differential diagnoses

  1. Linea nigra
  2. Linear focal elastosis
  3. Striae from topical steroid abuse, such as in the treatment of psoriasis.
  4. Cushing’s syndrome.

Primary diagnosis:

After a thorough consideration of other possible causes of this condition, I was able to narrow down the diagnosis based on my assessments and patients present condition to be Striae gravid arum.

Pregnancy as we all know comes with different skin changes as the body adjust to the new normal of accommodating the baby such as the changes that occur within the connective tissues as the skin continues to stretch as the uterus enlarges leads to the stretch marks (Ball, J et.all 2019).  This evidence of stretch march shows poor skin elasticity which further puts the patient at risk perineal or vaginal tears due to poor elasticity. When stretch marks becomes evident, it’s as a result of damage to the dermal collagen and further dilation of blood vessels (Dains, Baumann & Scheibel, 2019).





PLAN: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.



Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Skin, hair, and nails: Student checklist. In Seidel’s guide to physical examination (9th ed.). St. Louis, MO: Elsevier Mosby.