Dr T Template Dermatology

SUBJECTIVE:
[text default="CC:" size=100]
HPI:
Pt was seen and examined:
[text size=5] year old [comment memo="Race: "] [text size=10 ][select value="male|female"] 
[checkbox name="variable_1" value="Patient with previous history of: "][text size=50]
[checkbox name="variable_2" value="They were last seen in dermatology:"][text size=10]
[checkbox name="variable_3" value="Pt complains of a skin lesion |Pt complains of a skin rash"][checkbox name="variable_4" value="Location: "][text size=50]
[checkbox name="variable_5" value="Started: "] [text size=50]
[checkbox name="variable_6" value="Description Free Text: "]
[textarea name="variable_7" default=""]
Pertinent Past Medical History:
[textarea name="variable_38" default=""]
[checkbox name="variable_12" value="Family History: "][checkbox name="variable_13" value="Melenoma |Non-melanoma Skin cancer "][text size=50]
[link memo="Go to Social History" mark="Social History"]
[mark name="Social History"]
[checkbox name="variable_18" value="Allergies to Drugs: Yes |Allergies to Drugs: No  |Married |Divorced |Widow/Widower |Single |Children: Yes| Children: "][text size=50]
OBJECTIVE:
Physical Exam:
General: The veteran is a [checkbox name="variable_19" value="Well Appearing |Ill Appearing |Healthy |Obese |Male |Female |In no acute distress |In acute distress "] 
Skin/Extremities: Inspected Skin of [checkbox name="variable_20" value="Face, Neck, Scalp, Chest, Abdomen, Back, and Upper Extremities including the Palms and Nail beds of the Fingers |Buttocks |Genitals |Breasts |Lower Extremities including Soles and Nail beds of the Feet"] [text size=50]
Dermatological Findings:[checkbox name="Variable_21" value="[comment memo="Steroid Atrophy: "]Hypopigmentation, prominence of underlying veins, thinning of skin, erythematous/purple striae.
[checkbox name="Variable_21" value="[comment memo="Actinic Keratosis: "]Erythematous, hyperkeratotic papules with scaling.
[checkbox name="Variable_22" value="[comment memo="BCC vs other: "]Pink papule with telangiectasias.
[checkbox name="Variable_23" value="[comment memo="Chronic eczematous inflammation: "]Confluent erythema with scaling and occasional crust and fissuring. 
[checkbox name="Variable_24" value="[comment memo="Hand Eczema: "]Erythema of palms with excoriations, scaling, and pruritus. History of irritant contact. 
[checkbox name="Variable_25" value="[comment memo="Ecchymosis: "]Greater than 1 cm erythematous or purple macules.
[checkbox name="Variable_26" value="[comment memo="Hypertrophic scar: "]Excess scar tissue growth that does not overgrow the original wound boundaries. 
[checkbox name="Variable_27" value="[comment memo="Keloid: "]Growth of excess scar tissue that overgrows the original wound boundaries.
[checkbox name="Variable_28" value="[comment memo="Lichen simplex chronicus: "]Purple, papules, polygonal, excoriations, scales, Reticular lines on flexor surfaces (history of scratching).  
[checkbox name="Variable_29" value="[comment memo="Milium: "]Small superficial cyst containing keratin, 1-2mm in size.
[checkbox name="Variable_30" value="[comment memo="Neurofibroma: "]Spongy flesh colored nodule. 
[checkbox name="Variable_31" value="[comment memo="Papilloma: "]
[checkbox name="Variable_32" value="[comment memo="Petechiae: "]1-2 mm erythematous or purple macules that do not blanch with pressure. 
[comment memo="Purpura: "]3-10 mm red or purple macules that do not blanch with pressure.
[checkbox name="Variable_33" value="[comment memo=""]
[checkbox name="Variable_34" value="[comment memo="Solar lentigos: "]
[checkbox name="Variable_35" value="[comment memo="Seborrheic Keratosis: "]Skin-colored/brown macules or papules with warty or stuck on appearance.
[checkbox name="Variable_36" value="[comment memo=""]Symmetric brown or pink, macules or papules 3-7mm.
[checkbox name="Variable_37" value="[comment memo="Wart: "]Skin-colored/pink/brown hyperkaryotic papules with punctate hemorrhages.
[checkbox name="Variable_38" value="[comment memo=""]
[checkbox name="Variable_39" value="[comment memo=""]
[checkbox name="Variable_40" value="[comment memo="Wheals/Hives: "]Transient Less than 24 hours well-circumscribed, superficial edematous papules or plaques that are white to pale red and often appear and disappear over a period of hours."]
Assessment and Plan:
Diagnosis:
[textarea name="variable_39" default=""]
[checkbox name="Variable_32" value="Steroid Atrophy:|Actinic Keratosis: |Solar lentigos: |Seborrheic Keratosis: |symmetric brown or pink, macules or papules 3-7mm.|Wart: |Papilloma: |Milium:  |Petechiae: |Purpura: |Ecchymosis: |Wheals/Hives: |Hypertrophic scar: |Keloid: "]
[checkbox name="Variable_33" value="Medications Prescribed: |option B|option C"]
[checkbox name="variable_43" value="Dermatitis Tx: 
• Moisturizer BID every day (lotions, creams, or ointments)
• The best time for application of a moisturizer is after bathing and showering when skin is still damp
• The best moisturizer is petroleum jelly or an ointment
• The next best moisturizer is a cream
• The worst is a lotion due to having alcohol; therefore, they dry the skin

Good choices for cleansers/moisturizers and shampoos are below (most of which are fragrance free)
• Cetaphil cleanser and cream
• Dove sensitive skin cleanser
• Dove Nutrium cleanser
• Cerave cleanser and cream
• Vanicream cleanser and cream
• Free and clear shampoo and conditioner

For patches of dermatitis:
• Topical steroids is appropriate for a specified time (this helps reduce side effects of tachyphylaxis, skin thinning/atrophy-as evidenced by shiny skin/telangiectasia/striae/skin tearing/purpura; folliculitis/acne; and rarely significant systemic absorption).   
• Different topical steroids, possibly different dosages, and different delivery methods (lotion, gel, cream, and/or ointment) may be used on different parts of the body."]
[checkbox name="variable_40" value="Seborrheic Dermatitis of face Tx: 
• Ketoconazole cream BID PRN to areas of involvement with scaling. "]
[checkbox name="variable_41" value="Seborrheic Dermatitis of Scalp Tx: 
• Shampoo at least 3-4x/week with below medicated shampoo
• Longer period of lathering (5+ minutes)
• If one wants to shampoo daily, that is fine, but use your non-medicated shampoo(s).
• If one wants to shampoo with your non-medicated shampoo after using below, for instance, because you like the smell of the non-medicated shampoo that is fine.
• Recommended shampoos for SD are below and one should use:
• One of them 3x/week
Ketoconazole shampoo MWF for scalp shampoo, and if after 6 weeks no improvement move to next step
• Two of them alternating every other month and using 3x/week
Shampoos:
Ketoconazole, Salicylic acid, Selenium containing, Zinc containing
Selenium sulfide (2.5%), ketoconazole shampoos may help by reducing (Malassezia) yeast scalp reservoirs. Shampoos many be used on truncal lesions or in beards but may cause inflammation in the intertriginous or facial areas. 
****Topical corticosteroids may hasten recurrences, may foster dependence because of rebound effect, and are discouraged except for short-term use. "]
[checkbox name="variable_45" value="Sun damaged skin Tx: 
• Photoprotection daily
• SSE monthly
• Veteran advised that is will be their responsibility to both make and keep dermatology appointments."]
[checkbox name="variable_42" value="Tinea Cruris Tx:
• Apply topical antifungal cream BID for the designated time by your health care provider
• Put sox on before underwear, so as not to drag foot fungus up to skin of groin
• Wash hands after touching feet/clipping toenails
• Use shower thongs
• If after appropriate treatment for time allotted by healthcare provider, the condition has not resolved, please be revaluated by your healthcare provider as there are several conditions that may look/act similar to TC"]
[checkbox name="Variable_34" value="At Home Care: |Gently massage thin layer of prescribed topical medication onto affected area. |Use sunscreen daily. |Use protective clothing with wide brimmed hat daily. |Every Day |BID |TID |Every other day |MWF |M-F "]
[textarea name="variable_35" default=""]
Return to Clinic:
[checkbox name="Variable_37" value="3 Months |6 Months |1 Year"][text size=10]
Assisted by Student Dr Eric Harris