Question

A 42-year old female presents with a complaint of a papule on her left forearm for the past 2 months that “looks funny”. Denies itching, scaling, drainage, or other complaints.

question:

1. what questions you would ask the patient, what physical exam elements you would include, and what further testing you would want to have performed?

• In SOAP format, list:
  • Pertinent positive and negative information
  • Differential and working diagnosis
  • Treatment plan, including: pharmacotherapy with complementary and OTC therapy, diagnostics (labs and testing), health education and lifestyle changes, age-appropriate preventive care, and follow-up to this visit.

Answer 1

SOAP format is the explain or documentation of current condition in the form of Subjective,Objective,Assessment and Plan for further evaluation or treatment,

PAPULES

Essentials of Diagnosis

- Verrucous papules anywhere on the skin or mucus membranes, Usally no larger than 1 cm in diameter,

- Prolonged incubation period avg 2-18 months,

- Spontaneous cures are frequent in common warts ( 50% at 2 yrs),

- Recurrences are frequent.

General considerations

- Warts are caused by Human Papilloma viruses,

Clinical findings:

- Usally no symptoms,

- Tenderness on Pressure occurs with plantar warts,

- Itching occurs with ani genital warts,

- Flat warts are most evident under oblique illumination,

- Periungual warts may be dry, fissured and hyperkeratotic and may resemble gang nails,

- Plantar warts resemble plantar corns or calluses

Differential Diagnosis:

- Hypertrophic actinic keratoses or Squamous Cell Carcinomas are look like warts appearance,

- Secondary syphills,

- Lesions of molluscum contagiosum are pearly with a central dell,

- In AIDS, warts like lesions caused by VZV.

Prevention:

Administration of vaccine against certain genital HPV types can prevent and reduse cervical Dysplasia,

- Recommended for teenagers and young adults.

TREATMENT:

aimed at inducing Wart free intervals for as long as possible without scarring,

- No treatment guarantee a remission or prevent recurrences.

Treatment mainly two modes,

1. Removal,

2. Immuno therapy.

Removal by:

  1.Liquid Nitrogen,

2. Keratolytic agents and occlusion,

3. Podophyllum resin,

4. Imiquimod,

5. Operative removal,

6.Laser therapy,

OTC : apply Bleomycin

Immunoyherapy:

Squaric acid,

Inj: candida antigen,

Physical modalities: soaking of warts in hot water for 10 to 30 minutes.