[NP-Clinical] Derm

[Rose Moran-Kelly]

speaking of RPR...I had a patient over the weekend who had a rash.
Macular erythematous, (not pink but red), generalized but started on
his face and then spread down.  I had the pleasure of calling him back
yesterday to tell him I knew the cause and that he needed to return
for some pcn.  This is the first syph I have diagnosed.  I do remember
being taught 2 things....Keep syph in the DD of all rashes..... and
all itchy excoriated rashes are scabies until proven otherwise.
Rose

On 5/16/07, Andy Craig <aec-618 at carolina.rr.com> wrote:
>
>
> Molluscum contagiosum??  Or flat warts?
>
>
>
> Andy Craig, NP
> Charlotte, NC
>
>
>
> -----Original Message-----
> From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
> On Behalf Of Lisa Meyer
> Sent: Wednesday, May 16, 2007 2:49 PM
> To: np-clinical at nurse.net
> Subject: [NP-Clinical] Derm
>
>
> Another Derm question for all...
>
> I had a 20 something, very anxious, caucasion, heterosexual male yesterday
> that presented to the emergency dept. initially with a complaint of a
> "cold-sore in my nose".  It had been increasing over 2 weeks time.  R nasal
> mucosa was tender, erythematous and had yellow crusts.  He had not had a
> similar lesion before.  I told him that I though he likely had impetigo, not
> a cold sore, and advised antibiotic.  He then asked me if I could do "a
> bunch of labs to see if I'm alright".  Confused, I asked him what he thought
> might be wrong.  At first, he says that he coughs sometimes and he's a
> smoker, so he thinks maybe he has cancer.  After discussing this with him
> for some time and offering him a family practice referral (he had no
> primary), he blurts out that "Well what if I think I have an STD?!"
>
> Now we're getting to the issue... He noted some red spots on his penis 2
> days ago.  They have not changed since he noted them.  They do not itch or
> cause discomfort.  There has been no drainage or crusts.  No penile
> discharge or dysuria.  Single "one-night stand" new partner sexual encounter
> 2 months ago.  Denies fever or chills.  Reports fatigue over the last few
> months and lightheadedness off and on--"probably related to my terrible
> diet".  There are 5-6 small (1-2 mm) round and oval, erythematous lesions
> that are flat, some appear perhaps slightly ulcerated.  They are shiny
> (almost appear moist) but dabbing with cotton tipped applicator did not
> reveil drainage.  No crusts.  Non tender.  Not vesicular, and certainly did
> not appear as any herpes I've ever seen before--lesions not clustered, but
> diffusely scattered around the distal 1/4 of the shaft.  None on the glans.
>
> Any clues?  Could they somehow be related to the impetigo I diagnosed in the
> nose?  I've never seen penile impetigo and these were not crusty, but I've
> got no other ideas.
>
> Lisa
>
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