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CC: Pruritis and Dermatitis

HPI: AD is a 23 y/o pleasant and positive female PTC with a CC of pruritis and dermatitis like skin rash around her neck and forearms. The itching and inflammation stated 3 weeks ago and is extremely itchy. The pruritis seems to be “non-stop” and scratching temporarily relieves the sensation but leaves the skin drier and flaky. Some skin flakes off with scratching. The pruitits is worse at night especially when she is trying to fall asleep and this prevents her from doing so. She is only getting a few hours of uninterrupted sleep at night. It is a 6/10 for discomfort during the day and 9/10 at night. She also states that she feels more stressed and over whelmed recently especially since starting to see patients of her own in the clinic. Cold application seems to help. She is in distress due to discomfort and lack of sleep, otherwise a healthy and high spirited young women.

Physical Exam

Skin: Erythemetous base that is confluent and wraps around her neck with generalized declamation. Papulosquamous and eczematoid. Also seen on forearms.

Mental Status Exam

AD is appropriate weight and height for age and gender. She is a pleasant looking female with clean casual attire. The patient has good eye contact was pleasant and willing to try anything to help her discomfort. Her speech is within normal limits. She has a happy cheerful disposition with good judgement and insight and is just distressed about her skin and it's impact on her sleep. She does seem to scratch often especially when talking about it.

PMH

AD is healthy 23 year old with an unremarkable medical history. She is a student at SCNM in her 3rd year. She likes school and is very excited about this medicine and being part of this profession. She has noticed becoming more overwhelmed and stressed since starting to see patients at the clinic 12 weeks ago. She wants learn everything so she can be the best doctor possible to help her patients. She admits she is hard on herself.

ROS: Occassionally she has GI upset which she believes comes from a gluten sensitivity as she notices it after eating foods with gluten. She feels bloated, has cramping and notices dry patches of skin with pruritis

Interview

"cold application makes itching feel better"

Imagines self jumping into a cool stream

"feels as if skin is tingling

and suffocated

Medical Hypnosis

Ideal situation would be to decrease itching, flaking and redness. Feels self conscious about how it looks. The more I think about it the more it itches and the more I get stress out about it affecting my sleep.

Emily Poccia

Treatment & Results

30 min hypnotherapy session given

using progressive muscle relaxation followed by imagery of a control box for pruritis, cool stream and her skin breathing

Patient reported feeling much less itchy in the following week and 2 weeks later reported erythema and flaking is resolved!

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