When newFNP started this little blog, she had fully intended for it to provide some helpful hints to new NPs and NP students, rather than solely using it as a sounding board for complaints and to vent her own personal frustrations. To that end, newFNP would like to share a case with her readers.
Monday, July 21, 2008
As newFNP has previously noted, she really enjoys derm. It is something that other providers, however, fear and dislike. And newFNP understands - derm can be tricky and disgusting. When the skin goes south on you, it can really go south!! NewFNP works with one provider in particular who really dislikes derm and knows that newFNP really likes it. She consults newFNP routinely on her derm cases and newFNP happily examines and provides sage (she hopes) counsel.
This provider pulled newFNP into the room today to show her an extraordinary lesion. It was more than a lesion, really. It was a breast plate of erythematous papules and pustules on an otherwise healthy mid-twenties man. It was acneiform but newFNP immediately recognized that it was not acne. His face and the majority of his back were spared. There were no open comedones, nor were there nodules. It evolved rapidly over the course of two weeks. It was pruritic. His alcohol-based Mexican topical medicine was drying his skin, but not his pustules.
As newFNP's patients love to ask her, mostly when questioning newFNP about the mysterious etiology of a long-gone headache or tingly fingers or gas, "Porque sera?" Loosely translated, this means "Why could this be happening to me?" Often times, newFNP doesn't have an answer.
This time, she does.
NewFNP has her money on pityrosporum folliculitis, a condition caused by yeast and frequently misdiagnosed as acne. She'll let you know what the final outcome is, but she advised her colleague to check the patient's sugar and HIV status and to start him on a combination of topical (BID) and oral (200mg QD x 30 days) ketoconazole. Clinical improvement with the anti-fungals supports the diagnosis.
This is so one of those cases in which newFNP should have snapped a picture with her camera phone and sent in the case to a journal. But newFNP didn't think of that at the time. Son of a bitch!
Alas, fame will elude newFNP once again.