PHYSICAL EXAMINATION

VS: T 37°C, P 78/min, R 16/min, BP 126/78 mmHg

PE: On examination, the lesions were raised nodules in the center and scaling at the peripheries, covering a large area on his head (Fig. 71-1). There were also a few small pustules on the scalp.

FIGURE 71-1 Raised lesions on the scalp covering a large area in the back of the head on this patient.

(Courtesy of Centers for Disease Control and Prevention, Atlanta, GA.)

LABORATORY STUDIES

Blood

Serum chemistries: Not done

Diagnostic Work-Up

Table 71-1 lists the likely causes of lesions (differential diagnosis). A clinical diagnosis of ringworm was considered. Investigational approach may include

TABLE 71-1 Differential Diagnosis and Rationale for Inclusion (consideration)

Rationale: Allergic reactions can produce significant lesions, which may be localized, making them difficult to distinguish from infections. Parasitic infections usually have geographic exposure history. Ringworm infections, caused by dermato-phytes, are common in children and distinctly unusual in adults. Classic clinical features can help in presumptive diagnosis, but occasionally a bacterial superinfection due to Staphylococcus or Streptococcus can confound the clinical diagnosis. Viral exanthems are not usually confined to the scalp, but occur more commonly as part of a systemic illness.

• Wood’s light

• Direct mount microscopy

• Culture of skin scrapes to demonstrate fungus