Case Study Analysis
Leslie Zellers
Advanced Pathophysiology- NURS 6501C
Dr. Katese Rutherford
12/2/25
, Case Study: Evaluation of a Progressive Pruritic Rash in a 32-Year-Old Woman
Introduction
A 32-year-old female teacher, Sarah L., presents with a 2-week history of a worsening
pruritic rash affecting the palms, elbows, and flexural regions. She describes increasing
erythema, dryness, cracking, and nocturnal itching. Her medical history includes mild seasonal
allergies, and her family history is notable for maternal eczema. She recently began using a new
scented lotion and moved into an older home. Physical examination reveals erythematous
plaques with silver-white scale on the elbows, lichenified patches in the antecubital and popliteal
fossae, and mild nail pitting. Laboratory results show elevated eosinophils (7%) and elevated IgE
(250 IU/mL), with a negative KOH scraping. Based on the clinical picture and diagnostic data,
eczema—likely atopic dermatitis or allergic contact dermatitis—is the most probable diagnosis,
although some psoriatic features warrant consideration.
Differential Diagnosis
1. Atopic Dermatitis (Most Likely)
Several clinical features strongly support atopic dermatitis (AD). First, the distribution
involving flexural areas, the presence of lichenification, and intense pruritus—especially
nocturnal—are hallmark characteristics of AD in adults (Eichenfield et al., 2023). Additionally,
her elevated serum IgE and eosinophilia align with the immunologic profile commonly seen in
atopic disorders (Kim & Leung, 2022). The patient’s family history of eczema further increases
her risk, as AD has well-established genetic and atopic links.
Leslie Zellers
Advanced Pathophysiology- NURS 6501C
Dr. Katese Rutherford
12/2/25
, Case Study: Evaluation of a Progressive Pruritic Rash in a 32-Year-Old Woman
Introduction
A 32-year-old female teacher, Sarah L., presents with a 2-week history of a worsening
pruritic rash affecting the palms, elbows, and flexural regions. She describes increasing
erythema, dryness, cracking, and nocturnal itching. Her medical history includes mild seasonal
allergies, and her family history is notable for maternal eczema. She recently began using a new
scented lotion and moved into an older home. Physical examination reveals erythematous
plaques with silver-white scale on the elbows, lichenified patches in the antecubital and popliteal
fossae, and mild nail pitting. Laboratory results show elevated eosinophils (7%) and elevated IgE
(250 IU/mL), with a negative KOH scraping. Based on the clinical picture and diagnostic data,
eczema—likely atopic dermatitis or allergic contact dermatitis—is the most probable diagnosis,
although some psoriatic features warrant consideration.
Differential Diagnosis
1. Atopic Dermatitis (Most Likely)
Several clinical features strongly support atopic dermatitis (AD). First, the distribution
involving flexural areas, the presence of lichenification, and intense pruritus—especially
nocturnal—are hallmark characteristics of AD in adults (Eichenfield et al., 2023). Additionally,
her elevated serum IgE and eosinophilia align with the immunologic profile commonly seen in
atopic disorders (Kim & Leung, 2022). The patient’s family history of eczema further increases
her risk, as AD has well-established genetic and atopic links.
