HISTORY

CHIEF COMPLAINT

Gwen is a 23 year old woman who reports sudden worsening of a chronically dry patch of skin on her right knee along with the appearance of many smaller areas of dry red skin over her entire torso.

HISTORY OF PRESENT ILLNESS

Over the last twenty-four hours, Gwen noted the sudden appearance of a new rash on her upper chest. Now the rash involves the entire torso and the proximal extremities. Gwen describes these red, oval areas as very itchy, but not painful. Two weeks ago, Gwen was diagnosed with strep throat. She was treated for strep throat with penicillin and seemed to recover uneventfully. Gwen now denies fever and joint pain.  Gwen does not wear jewelry. She denies wearing new clothing recently.

PAST MEDICAL HISTORY

Gwen is healthy, has had no previous surgery, but suffered from childhood asthma.

SOCIAL HISTORY

Gwen has been married for five years, and works at a local superstore in the household goods section. She has a 2 year-old son.

FAMILY HISTORY

Gwen's father died when she was 11 years old. Gwen remembers her father having something wrong with his skin, but doesn't think it was serious. Gwen's mother has been treated for actinic keratosis.

PHYSICAL EXAM

GENERAL

Healthy-appearing 23 year old woman in no acute distress.

SKIN

The patient's trunk and proximal extremities were covered with small (1x 1 cm), well-circumscribed, 
red, raised plaques. These plaques were covered with a thick, silvery-white scale. A similar-
appearing, but larger plaque was noted on the patient's right knee.   Fingernails demonstrated 
pitting bilaterally.
 
No other lesions, inflammation, or swelling. Normal skin coloration. No evidence of stasis. No 
ulceration. No excoriation. No edema. Normal skin turgor.