Striae Gravidarum: A Comprehensive Differential Diagnosis and Treatment Plan
Assignment: Differential Diagnosis for Skin Conditions
To Prepare(NURS 6512)
- Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
- Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
- Consider which of the conditions is most likely to be the correct diagnosis, and why.
- Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
- Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
- Download the SOAP Template found in this week’s Learning Resources and use this template to complete this Lab Assignment.
The Lab Assignment Note: Make up a patient’s History
- Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
- Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.
No patient history was provided. You can form your patient history.
Week 4 Skin Comprehensive SOAP Note Template
- Patient Initials: _______ Age: _______ Gender: _______
- Chief Complaint (CC):
- History of Present Illness (HPI):
- Past Medical History (PMH):
- Past Surgical History (PSH):
- Sexual/Reproductive History:
- Personal/Social History:
- Health Maintenance:
- Immunization History:
- Significant Family History:
- Review of Systems:
- Cardiovascular/Peripheral Vascular:
- Physical Exam:
- Vital signs:
- Heart/Peripheral Vascular:
- Diagnostic results:
CHOOSE ONE SKIN PROBLEM ONLY
Patient Initials: T.R. Age: 32 years Gender: Female
Chief Complaint (CC): “The skin on my abdomen has several dark but painless lines. I have been having them since my sixth weeks of pregnancy. A recent photo of my abdomen is as shown in picture no. 2 in the file.”
History of Present Illness (HPI): T.R. is a 32-year-old African American who has come to the hospital unaccompanied. In addition to obtaining her routine antenatal care, T.R. is concerned about several dark marks that are appearing on her abdomen. As reported by T.R., the marks started to develop when she was in her sixth weeks of pregnancy and they have become darker. She thought they will soon disappear but they have not. She has been pregnant for 35 weeks now. T.R. is not using any potent corticosteroids. She denies redness or itchiness of the darkened lines.
- Folic acid supplements
- Iron supplements
Denies food or drug allergies
Past Medical History (PMH):
1.) Tonsilitis during adolescent years
3.) Malaria 4 months ago
Past Surgical History (PSH):
Denies having an operation before.
T.R. is of the female gender. Her first menarche was at 13 years. She reports have regular menstrual cycle before her pregnancy. She is at gravida 1, para 0. T.R. denies experiencing any serious complications with her current pregnancy.
She had a pap smear test before she became pregnant and results were negative.
T.R. indicates that she is married and faithful to her husband. She is an office secretary and her husband is an accountant. The couple denies consuming cigarettes or alcohol.
Covid Vaccine: AstraZeneca- 1st dose 8/9/2020, 2nd dose 10/8/2021
Significant Family History:
Both parents are alive and healthy.
T.R.’s primary diet comprises of carbohydrates, fruits, and vegetables with little fat.
Review of Systems:
General: Reports a slight increase in weight due to pregnancy. Denies fever.
HEENT: Does report physical head injury or headache. Denies vision-related issues. Does not report hearing loss or ear pain. Denies nasal congestion or discharge. Does not report mouth ulcers. Denies hoarseness in the threat.
Breasts: Does not report pain, redness, lesions, or masses.
Respiratory: Denies wheezing or breathing difficulties.
Cardiovascular: Denies chest discomfort or dyspnea.
Gastrointestinal: Does not report abdominal pain or diarrhea.
Genitourinary: Reports increased urination frequency.
Musculoskeletal: Does not report joint pain or stiffness.
Skin/hair/nails: Indicates that there has been an increase in the number of dark stretch marks on her abdomen.
Vital signs: Temperature; 35.6 degree Celsius, Blood pressure; 132/80, Pulse; 92 beats per minute, weight; 157.6 pounds, respiratory rate; 20 breaths per minute.
General: Alert and oriented to time, place, and person.
HEENT: Head is negative for trauma. Eyes lack evidence of lesions or swelling. Ear canal is clear. Nasal mucosa is pink and hairy. Absence of mouth ulcers. Throat is non-erythematous.
Neck: No goitre.
Chest/Lungs: No rubs, wheezes, or crackles, rubs.
Heart/Peripheral Vascular: S1, S2. Normal heart rate. No murmurs or gallop.
ABD: Evidence of abdominal distention and several dark striae.
Musculoskeletal: Good balance. Normal gait.
Neuro: Sings of good consciousness. No evidence of memory, language or speech, problems.
Skin: Smooth and warm skin. Several hyperpigmented striae or streaks on the distended abdomen.
Diagnostics/Lab Tests and Results:
- Davey’s Severity Score: There is evidence of severe stretching confirmed by a score of 6 (Solt & Kanza, 2022).
- Fitzpatrick Skin Type Scale: Type IV skin. Easily tans but hardly burns (Solt & Kanza, 2022).
- Dermoscopy: Striae have increased hyperpigmentation/melanization (Farahnik et al., 2017).
Differential Diagnoses (DDx):
- Striae gravidarum
- Linear focal elastosis
- Abdominal scar
- Steroid atrophy
Primary diagnosis: Striae gravidarum
Rationale: A number of factors link the features presented in the photo with Striae gravidarum. These include; being a female in 35th weeks of pregnancy, dark atrophic linear streaks/ scars on the abdomen, and the absence of other risk factors that can be associated with the symptoms such as the use of corticosteroids (Farahnik et al., 2017).
- Apply topical tretinoin ≥ 0.05% once a day at bedtime (Farahnik et al., 2017; Mayo Clinic, 2022).
Farahnik, B., Park, K., Kroumpouzos, G., & Murase, J. (2017). Striae gravidarum: Risk factors, prevention, and management. International Journal of Women’s Dermatology, 3(2), 77–85. https://doi.org/10.1016/j.ijwd.2016.11.001
Mayo Clinic. (2022). Tretinoin (topical route). https://www.mayoclinic.org/drugs-supplements/tretinoin-topical-route/proper-use/drg-20066521
Solt, K., A., & Kanza, G., D. (2022). Effects of olive oil on striae gravidarum in primiparous women: A randomized controlled clinical study. Alternative Therapies in Health and Medicine, 28(4), 34–39.