DISCUSSION BOARD
DERMATOLOGY CASE STUDY
ACC/AHA Guidelines
Chief complaint: " I have scaly crust in sole of feet and moist white crusts between my toes since I started using boots warm weather".
HPI: E.D a 45-year-old hispanic female presents to the clinic for complaint of itching in feet and scaly curst in sole of feet and moist white crusts between toes. She developed a red, itchy rash consistent with hypersensitivity reaction. She also indicates that she has noticed that her symptoms are worsening for past 2 weeks and it started after she started to use boots in warm weather. She has symptoms of red, itching rash consistent with a hypersensitivity reaction and tinea pedis. She wore about 2 weeks ago her mother's shoes without socks and her mother has history of Tinea Pedis.
She has tried lotrimin AF cream for itching and it did not help relief her symptoms. She has not tried other remedies.
Denies associated symptoms of fever, chills, pain or any other symptoms.
PMH:
Diabetes Mellitus, type 2. Peripheral Vascular disease. Varicose Veins.
Surgeries: None
Allergies: Penicillin
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Social history:
High school graduate, married and no children. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago.
Family history:
Both parents are alive. Father has history of DM type 2, Tinea Pedis.
Mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: + 1 pitting leg edema. + Varicose veins.
Skin: + rash crusted white in feet and inter-digit in feet.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0 po P 88 R 22, non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.
NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.
LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.
HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.
GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.
SKIN: +Dryness, No open lesions. +Dry crusts in sole of feet. + moist crust in between toes.
PSYCH: Normal affect. Cooperative.
Labs:: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98
A: Primary Diagnosis: Tinea Pedis
Secondary Diagnoses:
Atopic Dermatitis
Xerosis
Pruritus
Differential Diagnosis:
Peripheral Vascular Disease (PVD) (173.9)
P:
Medications:
Tylenol 650 mg PO Q4 hours as needed for arthritis pain
Labs: CBC with diff to evaluate for infection and baseline lab. CMP, PT/INR to evaluate status of liver and kidneys.
Referrals: may refer based on effect of medication therapy given for 2 weeks.
Follow up: return to office in 2 weeks to evaluate her symptoms.
Additional lab results:
Fungal culture confirm that she has fungal infection.
Question: As an NP student, needs to determine the medications for Tinea Pedis.
According to the ACC/AHA Guidelines, what antifungal medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format.