Basic DDx Case Play: Itchy Skin Assessment in a Pediatric
Patient
Comprehensive Pediatric Case Study
1. Patient Demographics & Identifying Data
• Initials: A.S.
• Name: Alicia Smiley
• Age: 13 years
• Gender: Female
• Ethnicity: Asian American
• Height: 5'2" (157 cm)
, • Weight: 104 lb (47.3 kg)
• Occupation: Eighth-grade student
• Living Situation: Lives with her parents and younger
brother in a suburban home. No pets. No tobacco
exposure in the household.
• Source of Information: Patient and mother; both are
reliable historians.
2. Chief Complaint (CC)
"I developed a red, itchy rash after hiking in the woods last
weekend."
3. History of Present Illness (HPI) – OLD CARTS
Onset
The rash began 3 days ago, approximately 48 hours after a
family hiking trip through a wooded park.
Location
The rash involves the left forearm, right lower leg, and the left
side of the neck.
Duration
The rash has progressively worsened over the past three days.
, Characteristics
The patient describes the rash as very itchy with small blisters
that ooze clear fluid after scratching.
Aggravating Factors
• Scratching
• Heat
• Sweating
• Tight clothing
Relieving Factors
• Cool compresses
• Oatmeal baths
• Calamine lotion
Treatment
Mother applied calamine lotion and cool compresses with
temporary relief. No prescription medications have been used.
Severity
Pruritus: 8/10
4. Past Medical History (PMH)
Medical History
Patient
Comprehensive Pediatric Case Study
1. Patient Demographics & Identifying Data
• Initials: A.S.
• Name: Alicia Smiley
• Age: 13 years
• Gender: Female
• Ethnicity: Asian American
• Height: 5'2" (157 cm)
, • Weight: 104 lb (47.3 kg)
• Occupation: Eighth-grade student
• Living Situation: Lives with her parents and younger
brother in a suburban home. No pets. No tobacco
exposure in the household.
• Source of Information: Patient and mother; both are
reliable historians.
2. Chief Complaint (CC)
"I developed a red, itchy rash after hiking in the woods last
weekend."
3. History of Present Illness (HPI) – OLD CARTS
Onset
The rash began 3 days ago, approximately 48 hours after a
family hiking trip through a wooded park.
Location
The rash involves the left forearm, right lower leg, and the left
side of the neck.
Duration
The rash has progressively worsened over the past three days.
, Characteristics
The patient describes the rash as very itchy with small blisters
that ooze clear fluid after scratching.
Aggravating Factors
• Scratching
• Heat
• Sweating
• Tight clothing
Relieving Factors
• Cool compresses
• Oatmeal baths
• Calamine lotion
Treatment
Mother applied calamine lotion and cool compresses with
temporary relief. No prescription medications have been used.
Severity
Pruritus: 8/10
4. Past Medical History (PMH)
Medical History
