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
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