2 July, 2014
I saw a rash similar in appearance to the one above and at first assumed it was a 2nd degree blistered burn. That is until I found out more history and looked closer at the vesicles.
An 11 year old female presents for blisters on R shoulder on a Thursday.
Patient was playing water polo all weekend and was exposed to the sun (not reapplying sunscreen). Monday, pt was playing outside in dry leaves at school (was wearing T-shirt). Monday complained of muscle spasm pain in the R shoulder. Mom gave massage with itch cream (caladryl) and gave oral benadryl on Tuesday. Tuesday noticed redness on shoulder and dots with white heads localized to R shoulder. Tuesday night had worsening pain that woke her up. On Wednesday, lesions began to get bigger and look more like blisters. No longer complaining of pain today (Thurs).
Also reports face dryness from sun and chlorine reaction.
Denies fever, NVD, rash in other areas, sunburns to other areas, decrease fluid intake, decrease urine output, current pain, body aches.
PMH: twin (ex 35 week) , elevated TSH with positive antibodies; migraine, right nasolabial asymmetry, overweight, goiter
Imm: up to date on vaccines including VZV
|Constitutional||Normal||No acute distress. Well nourished. Well developed.|
|Ears||Normal||Inspection – Right: Normal, Left: Normal. Canal – Right: Normal, Left: Normal. TM – Right: Normal, Left: Normal.|
|Nasopharynx||Normal||Nasal mucosa – Normal. Palate & uvula – Normal. Tonsils – Normal. Oropharynx – Normal.|
|Respiratory||Normal||Auscultation – Normal. Cough – Absent. Effort – Normal.|
|Cardiovascular||Normal||Heart rate – Regular rate. Rhythm – Regular. Murmurs – None.|
|Vascular||Normal||Capillary refill – less than 2 seconds.|
|Abdomen||*||Inspection – normal. Auscultation – normal bowel sounds. Palpation – no guarding, no rebound tenderness.|
|Skin||Comments||7cm x 5 cm erythema on top of right shoulder with central blisters (>10) and in confluence, +tan, facial peeling over cheeks, nose, and chin with facial hypopigmentation|
What’s your Differential Diagnosis?