Emergency Department Note 4.8

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A 32-year-old white male presents in the emergency department with a rash over his forehead, face, and neck, upper back over the past week or 2. He has had this a few times this year. Was once treated with Keflex with good relief. He also was given Bactroban, which he did not fill because it was too expensive. He states it burns. There is no itching, no other complaints. He does have a history of dry skin. Worked as a farmer but then switched to a mail contractor. When he started handling the mail, he noted he developed multiple blisters on his hands, and his hands have been raw since working there.

PAST MEDICAL HISTORY
Dermatitis.

PRESENT MEDICATIONS
None.

ALLERGIES
None.

SOCIAL HISTORY
He is single. Employed as a mail bagger.

FAMILY HISTORY
Negative for dermatitis.

PHYSICAL EXAMINATION
Over his forehead, there is a large area covering three-quarters of his forehead that is crusted over with some small amounts of clear discharge. He has another area just under his right eye, and then over his anterior chest and also his upper back. There are no intraoral lesions or other lesions on his body, and they do cross the midline.

Bactroban is ordered, but it is unavailable. He is going to fill a prescription for Bactroban tomorrow. He is discharged home.

CLINICAL IMPRESSION
1.Impetigo.
2.Dermatitis.

DISCHARGE INSTRUCTIONS
Bactroban cream twice daily. He does drive race cars. He was advised to wash his helmet and head mask daily after using it, possibly boiling it. Change his sheets.

Of note, also, on this physical examination, his hands were very red and the skin was tough. He states this is the way they always are. He was advised to use moisturizing creams and return to the ED should he have problems. He is going to follow with his private physician.
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