Patient is a 48-year-old Hispanic male presenting with intense itching localized to the inner elbows, knees, and inner thighs. On physical exam, burrows and vesicles were observed in these areas consistent with scabies. The patient was diagnosed with scabies and prescribed permethrin cream to apply from neck to feet and hydroxyzine tablets for itch relief.

1. Soap Note Acute Bartolinitis.
SOAP Note: SCABIES 2SCABIESPatient: F.D.Age: 48 years oldRace: HispanicGender:
MaleInsurance: Private insurance.SUBJECTIVEChief complaint: ” My skin itches a lot at
night”History of present illness (HPI): Patient is a Hispanic white male 48 year old who is
coming to consultation today reporting that for a week he is having a lot of itching in the
internal fold of elbows and legs that makes it difficult for him to sleep properly. He also says
he lived for two months with his mother in a shelter. Patient denies a history of dermatitis
or atopy and states that he is not using any OTC cream or lotion and the skin lesion has
increased as well as itchy.Past Medical History(PMH)Last annual physical exam was made
in January of current year.Chronic Condition: Essential Hypertension Controlled with
current treatmentCurrent Medication: Enalapril 20 mg 1 tab PO QDHospitalization: Patient
denies hospitalizations or invasive procedures.No history of mental illness or personality
disorders.No physical trauma or falls reported during the last twelve months.Surgeries:
Cholecystectomy 7 years agoExposure: Patient lived in a shelter for two months due to
economic problems that were already solved. No knows HIV exposure during the last year.
No blood transfusions or received other blood components or tissues.Environmental
exposure was negative to asbestos, radiations or other chemical substances. No exposure to
the sunlight during day activities for long periods of time.Immunizations: Immunizations up
to date (Flu Vaccine: 01/23/2019)Exercise: Patient refers frequently daily exercises.Diet:
Patient refers a “healthy diet” rich in whole grains, vegetables, fruits and proteins.Social
History: Patient is single, and lives with his mother in an apartment. The relationships
between family members is good. Client denies using drugs, alcohol or
cigarettes.Educational level: Middle School.Sexual Behavior: Patient is heterosexual and he
reported one sex partner during the past year. Client said that he always uses condom. No
risk behavior for STDs.Allergies: NKDA, No Food/Seasonal AllergyFamily Medical History:
Mother (75 y/o) Alive : HTN, Diabetes mellitus and Father: Unknown.Review of
systems:Systemic: The systemic symptoms presented at this time is skin itchy. No chills, no
neck rigidity. No weight loss.Head: No headache. No sinus pain reported, no mass, no
trauma.Neck: No pain or stiffness reported in this area. No swollen glands in the neck.Eyes:
No redness, pruritus or secretion. Denies blurred vision, double vision or other
conditions.Oto-laryngeal: No change in hearing, ringing in ears, neither ear pain. Not
presence of sinus/nasal congestion or bleeding gums.Breasts: No symptoms such as pain,
fulness sensation or discharge.Cardiovascular: Denies chest pain, palpitations, discomfort
neither occasional episodes of irregular rhythm.Pulmonary: Denies chest congestion,

2. wheezing, coughing, frequent infections or shortness of breath.Gastrointestinal: Normal
appetite. No dysphagia or heartburn. No nausea, vomiting or abdominal pain. No
hematochezia. No diarrhea or constipation.Genitourinary: No pain, hematuria or changes in
urinary habits. No cloudy urine or bad smell. No penile discharge.Endocrine: No symptoms.
No polyuria, no polyphagia.Hematologic: Denies easy bruising, loss of hair, heat/cold
intolerance, change in nails, enlarged glands, prolonged bleeding, increased thirst, or
hunger.Musculoskeletal: Denies limited range of mobility, joint pain or limited ROM. Denies
difficulty walking or trouble reaching above head.Neurological: Denies migraine, balance
problems, seizures or fainting lightheadedness, tremors or balance problems. Denies
muscle weakness, numbness or tingling.Psychological: Mood was euthymic, not feeling
restless or anxiety. No feeling hopelessness or depressed. No sleep disturbances, trouble
falling or staying asleep. Normal enjoyment of activities. Not easily distracted and no change
in thought patterns.Skin: The patient denies presence of white or brown spots, ulcer,
ecchymosis, new nevus. During the interview he reports a lot of itchy during night for the
las weeks localized in internal fold of elbows and legs.OBJECTIVEPhysical ExamVitals
Sign:BP-sitting L: 120/80 mmHgBP cuff size: RegularPulse Rate-Sitting: 78 bpmPulse
Rhythm: RegularRespiration Rate: 15 per minTemp-Tympanic: 98.1 F0Height 70
inWeight:188 lbs.Body Mass Index: 29.1 Kg/m2Body Surface Area: 1.97 m2Oxygen
Saturation: 98 %Pain Scale/Rate: 0/10General appearance: Patient alert and oriented.
Speech fluently. Currently; he no reflects discomfort in his face and posture. He is hydrated
without increase of temperature.Head: Normocephalic / no trauma. Scalp pink and dry. No
tenderness noted over frontal or maxillary sinuses.Neck: No visible mass and skin with
normal coloration. No palpable masses or tenderness, trachea is midline, thyroid without
nodules, no JVD, no lymph nodes.Eyes: Extraocular movement in both eyes are symmetric.
PERRLA, sclera is white, conjunctiva pink, no noted discharge. Normal visual acuity.Ears:
External auditory canal and meatus are normal. No swollen or reddened. Bilateral tympanic
membranes were intact and pearly gray with light reflex. No erythematous, scarred or
hemorrhage. No pus or serous exudate. No hearing loss.Nose: No external deformities of the
nose. Nasal mucosa moist and pink with clear drainage, septum midline. Nasal turbinate no
erythematous, no swollen. No sinus tenderness.Oral Cavity: Oral mucosa moist and pink.
Gums with normal appearance without swollen, bleeding or hypertrophy. Teeth, the
dentition are complete and good hygiene.Pharynx: Moist and pink with tonsillar
enlargement without lesions, plaques or exudate. No petechias, no strawberry
tongue.Lymph Nodes: No adenomegaly on observation on palpation in any of the ganglion’s
chains.Chest: Thorax symmetric, follow up the breading movement.Lungs: Respirations are
regular, equal, and unlabored with symmetrical chest expansion. Lung sounds clear to all
lung fields. No wheezing, stridor, crackles, or rhonchi noted. No increased tactile fremitus
noted.Cardiovascular: Regular rate and rhythm, heart sounds of S1 and S2, no extra heart
sounds, murmurs or bruits noted. PMI at 5th intercostal space, midclavicular line. No
pericardial friction rub heard. No gallops, murmurs, or opening snaps.All pulses 4+ palpable
and equal. No clubbing, cyanosis or edema noted. Bilateral carotid arteries without bruits.
Capillary refill test was normal.Abdomen:Inspection: Symmetric, no distended no visible
masses. The skin is normal, no scarsAuscultation: Bowel sound active in all 4 quadrants. No

3. bruits.Palpation: Abdomen soft, no mass, non-tender or guarding. No hepatomegaly or
splenomegaly.Percussion: Normal.Genitalia: Patient refused genital exam at this
time.Rectal: Patient refused rectal exam at this time.Musculoskeletal: Normal gait, no
limited range of mobility (joints). Normal inspection, palpation, muscle strength. Fingers,
feet and toes are normal.Neurological: Level of consciousness was normal. Patient oriented
in person, time and space. Speech clear and fluent. Normal sensory/motor exam. Deep
tendon reflexes symmetrical and equal bilaterally. Proprioception was normal. Balance, gain
and stance were normal. No peripheral neuropathy was noted.Psychiatric: Patient is
euthymic, with normal level of anxiety and depression. The affect was normal.Skin: Clean,
warm and dry without sores or bruises. No suspicious nevi, no bruises or ecchymoses. On
observation is noted the presence of burrows and vesicles in internal fold of elbows, knee
and inner part of both thighs. Also, it was observed excoriated papules.Hair: Normal
distribution according to the gender. No hair loss in the lower extremities was
observed.Nails: Pink with normal appearance. No clubbing of the finger nails. No
onychomycosis.ASSESSMENTPrimary Diagnosis: B86 ScabiesIt is an infestation of the skin
by the mite Sarcoptes scabiei that results in an intensely pruritic eruption with a
characteristic distribution pattern. The incidence of scabies undergoes cyclical fluctuations
on a worldwide basis, although all parts of the globe are not necessarily in the same phase
of the cycle at the same time. Transmission of scabies is usually from person to person by
direct contact. In adults, areas most likely to yield mites are between the fingers, sides of
hands, wrists, elbows, axillae, groin, breasts, and feet. Scabies usually presents with severe
itching, often worse at night, and nondescript erythematous papules.Differential
Diagnosis:Atopic Dermatitis: is a chronic inflammatory skin condition that appears to
involve a genetic defect in the proteins supporting the epidermal barrier. Exacerbating
factors in atopic dermatitis that disrupt an abnormal epidermal barrier include excessive
bathing, low humidity environments, emotional stress, xerosis or dry skin, overheating of
skin, and exposure to solvents and detergents.Impetigo: is a contagious superficial bacterial
infection observed most frequently in children. It may be classified as primary impetigo
direct bacterial invasion of previously normal skin or secondary impetigo infection at sites
of minor skin trauma such as abrasions, minor trauma, and insect bites, or underlying
conditions such as eczema. Variants of impetigo include non-bullous impetigo, bullous
impetigo, and ecthyma.Folliculitis: Multiple follicular-based erythematous papules or
pustules on chest and back.No burrows seen on physical exam.Other DiagnosisEssential
Hypertension (Controlled) I10Overweight E66.3PLANTherapeuticPermethrin 5% cream,
massage thoroughly into the skin from the neck to the soles of the feet x 1 time, cream
should be removed by washing after 8 to 14 hours. Apply a second time after two
weeks.Hydroxyzine tab 25 mg BID for 5 days.Non-TherapeuticPatient was instructed
regarding general measures:1. Treatment for those who were sexual and household
contacts within the preceding 1 month is recommended at the same time that the patient is
treated to prevent re-infestation.2. Immediately following any treatment, all bedding and
clothing should be washed in water that is 140°F or higher (≥60°C) and dried the day after
the first treatment to decrease the chance of re-infestation.3. Clothing or objects that cannot
be washed should be placed in a sealed bag for a week.No Test ordered/No needed to this

4. diagnosisFollow-ups/Referrals:Follow-up in 3 weeks. Also, the patient was instrumented to
return if the symptoms get worse.Bibliographic References:Chosidow O. Clinical practices.
Scabies. N Engl J Med. 2006;354:1718-1727.[AbstractChouela E, Abeldano A, Pellerano G, et
al. Diagnosis and treatment of scabies: a practical guide. Am J Clin Dermatol. 2002;3:9-
18.[Abstract]Hengge UR, Currie BJ, Jager G, et al. Scabies: a ubiquitous neglected skin
disease. Lancet Infect Dis. 2006;6:769-779.[Abstract]Heukelbach J, Feldmeier H. Scabies.
Lancet. 2006;367:1767-1774.[Abstract]Johnston G, Sladden M. Scabies: diagnosis and
treatment. BMJ. 2005;331:619-622.[Abstract]Johnstone P, Strong M. Scabies. Clin Evid.
2006:2284-2290.[Abstract]Strong M, Johnstone PW. Interventions for treating scabies.
Cochrane Database Syst Rev. 2007;3:CD000320.[Abstract]