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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

You are expected to take a brief history from Robert regarding a rash. A photograph of his rash will be available to you. There is no need to conduct any further examination. Outline to Robert your diagnosis and suggestions for management.

Scenario

Robert Kerslake is a 24-year-old chef with a rash on the outside of his right and left elbows. He has tried some 1% hydrocortisone cream purchased over the counter and it cleared the rash for a short time; however, it recurs each time he stops using it.

The following information is on his summary sheet:

  • Past medical history

  • Chickenpox aged eight

  • Medication

  • Nil recorded

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Lives alone

  • Smokes 10–20 cigarettes per day.

INSTRUCTIONS FOR THE PATIENT, ROBERT KERSLAKE

You are 24 years old and work as a chef. You work long hours and the kitchen is often very hot. A few months ago, you developed a rash on your elbows. You bought some hydrocortisone cream from a chemist and when you use it the rash goes; as soon as you stop using it, the rash reappears. The rash is only on your arms.

The rash is annoying you more and more and it is getting you down. Normally you like to socialise but the rash is making you stay home rather than going out with your mates and you are worried customers may think the rash is infectious.

You have no family history of skin disease and have no joint, hair or nail problems. You are keen to find out from the doctor what the rash is and what can be done about it.

When the doctor asks to look at the rash please show them the photograph. (Refer to Figure 3)

The following information is on your summary sheet:

  • Past medical history

  • Chickenpox aged eight

  • Medication

  • Nil recorded

  • Allergies

  • Nil known

  • Immunisations

  • Up-to-date

  • Social history

  • Lives alone

  • Smokes 10–20 cigarettes per day.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Open-ended questions to explore Robert’s concerns, ideas and expectations for the consultation.

Specific questions

Explore the symptoms of the rash and impact on his life

Ask about other involvement, e.g. joint pain, nails or hair

Ask about treatment so far

Observe clinical photograph.

Most likely diagnosis

Psoriasis.

Management

Confirm diagnosis of psoriasis

Education regarding psoriasis

  • — Inform psoriasis is non-infectious

  • — Treatment aimed at containment, not cure

  • — Discuss impact of stress and smoking1...

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