i-Human Case Review 2025/2026: 36-Year-Old
Adult With Progressive Itchy Rash |Advanced
Practice Clinical Case: Acute Contact Dermatitis
in a 36-Year-Old (Week 2, 6531)
, SOAP NOTE – 36-Year-Old With Itchy Rash (Week 2, Class 6531)
S – Subjective
• CC: “I have an itchy rash.”
• HPI: 36-year-old presents with a 4–5 day history of progressively worsening itchy rash.
Rash began on forearms and spread to upper arms, lateral neck, and upper chest.
Itching is constant, worse at night, mild burning with scratching. No pain, drainage, or
systemic symptoms. Patient tried OTC lotion without relief. Recently switched to new
scented laundry detergent; no new medications. No prior similar rash. Denies fever,
chills, shortness of breath, throat swelling, joint pain, nausea, vomiting, or recent illness.
• Allergies: None known.
• Medications: None new.
O – Objective
Vitals: BP 118/76 mmHg, HR 80 bpm, RR 16/min, Temp 98.4°F, SpO₂ 98% RA
General: Alert, oriented, no acute distress
Skin:
• Erythematous papules and plaques
• Mild excoriation
• Distribution: forearms → upper arms → lateral neck → upper trunk
• Borders ill-defined, slightly raised
• No vesicles, pustules, scaling, warmth, or drainage
HEENT: No swelling, oral lesions, or conjunctival injection
Respiratory: Clear bilaterally, no wheezing
Cardiovascular: Regular rate/rhythm, no murmurs, pulses 2+
Abdomen: Soft, non-tender, no organomegaly
Neurologic: Cranial nerves II–XII intact, strength/sensation intact
, Psych: Mood/affect normal, cooperative
A – Assessment
Primary Diagnosis: Allergic Contact Dermatitis (Most likely)
Differential Diagnoses:
1. Irritant Contact Dermatitis
2. Atopic Dermatitis
3. Urticaria
4. Tinea Corporis
5. Drug Eruption
Rationale: Rash morphology (erythematous papules/plaques), distribution, and history of
recent exposure to new detergent support allergic contact dermatitis. No systemic symptoms
or mucosal involvement.
ICD-10 Code: L23.9 – Allergic Contact Dermatitis, Unspecified Cause
P – Plan / Management
1. Avoid trigger: Discontinue new laundry detergent; avoid suspected irritants
2. Topical therapy: Medium-to-high potency corticosteroid cream (e.g., triamcinolone
0.1%) applied 1–2 times daily to affected areas
3. Antihistamine: Oral non-sedating antihistamine (e.g., cetirizine 10 mg daily) for itch;
consider sedating antihistamine at night if itching disrupts sleep
4. Skin care: Gentle, fragrance-free soaps; regular moisturizing
5. Patient education: Avoid scratching, trim nails, wash new clothing before wearing
6. Follow-up: Recheck in 1–2 weeks or sooner if rash worsens, spreads, or shows signs of
infection
7. Red flag instructions: Seek care immediately if rash spreads rapidly, develops blisters,
oozing, fever, swelling of lips/tongue, or difficulty breathing
Final Diagnosis
• Diagnosis: Allergic Contact Dermatitis
Adult With Progressive Itchy Rash |Advanced
Practice Clinical Case: Acute Contact Dermatitis
in a 36-Year-Old (Week 2, 6531)
, SOAP NOTE – 36-Year-Old With Itchy Rash (Week 2, Class 6531)
S – Subjective
• CC: “I have an itchy rash.”
• HPI: 36-year-old presents with a 4–5 day history of progressively worsening itchy rash.
Rash began on forearms and spread to upper arms, lateral neck, and upper chest.
Itching is constant, worse at night, mild burning with scratching. No pain, drainage, or
systemic symptoms. Patient tried OTC lotion without relief. Recently switched to new
scented laundry detergent; no new medications. No prior similar rash. Denies fever,
chills, shortness of breath, throat swelling, joint pain, nausea, vomiting, or recent illness.
• Allergies: None known.
• Medications: None new.
O – Objective
Vitals: BP 118/76 mmHg, HR 80 bpm, RR 16/min, Temp 98.4°F, SpO₂ 98% RA
General: Alert, oriented, no acute distress
Skin:
• Erythematous papules and plaques
• Mild excoriation
• Distribution: forearms → upper arms → lateral neck → upper trunk
• Borders ill-defined, slightly raised
• No vesicles, pustules, scaling, warmth, or drainage
HEENT: No swelling, oral lesions, or conjunctival injection
Respiratory: Clear bilaterally, no wheezing
Cardiovascular: Regular rate/rhythm, no murmurs, pulses 2+
Abdomen: Soft, non-tender, no organomegaly
Neurologic: Cranial nerves II–XII intact, strength/sensation intact
, Psych: Mood/affect normal, cooperative
A – Assessment
Primary Diagnosis: Allergic Contact Dermatitis (Most likely)
Differential Diagnoses:
1. Irritant Contact Dermatitis
2. Atopic Dermatitis
3. Urticaria
4. Tinea Corporis
5. Drug Eruption
Rationale: Rash morphology (erythematous papules/plaques), distribution, and history of
recent exposure to new detergent support allergic contact dermatitis. No systemic symptoms
or mucosal involvement.
ICD-10 Code: L23.9 – Allergic Contact Dermatitis, Unspecified Cause
P – Plan / Management
1. Avoid trigger: Discontinue new laundry detergent; avoid suspected irritants
2. Topical therapy: Medium-to-high potency corticosteroid cream (e.g., triamcinolone
0.1%) applied 1–2 times daily to affected areas
3. Antihistamine: Oral non-sedating antihistamine (e.g., cetirizine 10 mg daily) for itch;
consider sedating antihistamine at night if itching disrupts sleep
4. Skin care: Gentle, fragrance-free soaps; regular moisturizing
5. Patient education: Avoid scratching, trim nails, wash new clothing before wearing
6. Follow-up: Recheck in 1–2 weeks or sooner if rash worsens, spreads, or shows signs of
infection
7. Red flag instructions: Seek care immediately if rash spreads rapidly, develops blisters,
oozing, fever, swelling of lips/tongue, or difficulty breathing
Final Diagnosis
• Diagnosis: Allergic Contact Dermatitis
