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Skin: Erythemetous base that is confluent and wraps around her neck with generalized declamation. Papulosquamous and eczematoid. Also seen on forearms.
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.
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
"cold application makes itching feel better"
Imagines self jumping into a cool stream
"feels as if skin is tingling
and suffocated
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.
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!