[Solved] AR is a 7-month-old boy, is brought to your office by his mother, who is concerned about her son’s intermittent, pruritic rashes. She reports that the rashes – Fast, Quality and Affordable Assignment Expert

AR is a 7-month-old boy, is brought to your office by his mother, who is concerned about her son’s intermittent, pruritic rashes

Module 10 Discussion

Case Study: Dermatitis Case

AR is a 7-month-old boy, is brought to your office by his mother, who is concerned about her son’s intermittent, pruritic rashes. She reports that the rashes started when AR was about 4 months old and were initially concentrated on his cheeks and around his mouth. Since that time, the rashes seem to come and go and now also intermittently affect his trunk and extremities.

He frequently scratches the affected areas. His mother notes that the areas covered by his diaper are not involved. She has treated the condition with various “baby lotions” and is uncertain whether they help. She notes that she and her husband are not affected by any itchy rashes, and she doesn’t know of any close contacts who are experiencing this problem either. He is otherwise healthy and meeting developmental milestones. AR’s father has a history of asthma.

On examination, AR is attentive and appropriately interactive. Vital signs are within normal limits. Cutaneous examination reveals symmetric, ill-defined, brightly erythematous, scaling, pink patches on his cheeks and similar, although milder, patches on his trunk and extremities.

Your diagnosis is AR with atopic dermatitis.

What do you think is an appropriate first-line treatment for AR, please be specific about the agent recommended/prescribed. What counseling points, be specific with instructions you give his mother, including non-pharmacological treatment options. When would you want to follow up with AR?

Expert Answer and Explanation

Dermatitis Case Study

The First-Line Treatment for AR

Atopic dermatitis is a condition characterized by itchiness and dryness of the skin, tied to the autoimmune reaction. Considering the AR’s age and his clinical manifestations, the first-line treatment that would be suitable for him is the topical hydrocortisone 1% cream which is an example of the topical corticosteroid. Besides being an effective treatment for AR because of his age, the topical hydrocortisone provides a better alternative to the baby lotions, which have failed to remove the rushes.

As a low-potency corticosteroid, the topical hydrocortisone relieves the eczema-related pruritus considering that it addresses the issue of overactive autoimmune system. The selected medication is also ideal because it treats eczema which seems to cause the rush (Wollenberg et al., 2023). Applying a thin layer of the medication to the areas with rushes in the morning and evening is recommended. AR’s mother should apply the medication until the itchiness and the rushes disappear.

Counseling Points to give his Mother, Including Non-Pharmacological Treatment Options

When counseling AR’s mother, there are key points that are worth considering. It is important to highlight the significance of adhering to the prescription instructions because overuse of the cream particularly in the facial area can cause thinning of the AR’s skin. In addition to providing this information, it is important to inform the mother the factors that may activate the autoimmune response, and those that can trigger itching (Frazier & Bhardwaj, 2020).

Some of the things that the mother should consider in this case include some forms of detergents, soaps and fabrics. It is equally important to emphasize on the avoidance of the overheating of AR given that the sweat can exacerbate the clinical manifestations associated eczema. To avoid the damage of AR’s skin due to frequent scratching, it is important to remind the mother trim AR’s nails, ensuring that they remain short.

When I would want to follow-up with the AR

I would want to follow-up with AR to first to assess the mother’s adherence to the prescription instructions. By assessing AR’s progress, a provider can tell if the intervention they prescribed is effective. If during the follow-up they determine that AR is still experiencing itching, for instance, they can conclude that the treatment is infective. Thus, the follow-up would help the provider decide if the patient needs another treatment (Gür Çetinkaya & Şahiner, 2019). As a provider, I would follow-up with AR if the medication prescribed causes adverse side effects or if other symptoms recur following the application of the medications.

References

Frazier, W., & Bhardwaj, N. (2020). Atopic Dermatitis: Diagnosis and Treatment. American family physician, 101(10), 590–598. https://pubmed.ncbi.nlm.nih.gov/32412211/.

Gür Çetinkaya, P., & Şahiner, Ü. M. (2019). Childhood atopic dermatitis: current developments, treatment approaches, and future expectations. Turkish journal of medical sciences, 49(4), 963–984. https://doi.org/10.3906/sag-1810-105.

Wollenberg, A., Werfel, T., Ring, J., Ott, H., Gieler, U., & Weidinger, S. (2023). Atopic Dermatitis in Children and Adults—Diagnosis and Treatment. Deutsches Arzteblatt international, 120(13), 224–234. https://doi.org/10.3238/arztebl.m2023.0011.

Module 11 Discussion

Neurotransmitters and Mental Illness

MS is a 35 year-old female with newly diagnosed depression. You have started discussing initiating medication with her. She is a 4th-grade science teacher and asking you a lot of questions about what this means is happening in her brain. How would you explain to this patient how neurotransmitters work? Including, specifically how they affect mental illness. Which specific neurotransmitters would you address with her as they relate to her depression?

Expert Answer and Explanation

Neurotransmitters and Mental Health

How the Neurotransmitters Work including how they affect Mental Illness

As part of the central nervous system, the brain controls various aspects of the body functions ranging from the coordination of movements to thinking and functioning of the mental health. The brain has different components including neurotransmitters which take the form of chemicals, playing crucial role in information transmission. Like the brain, a neurotransmitter has components which support the exchange of messages. The brain has nerve cells responding of sending impulses that trigger the release of neurotransmitters (Teleanu et al., 2022). With the stimulation of these neurotransmitters, they pass to the target cell, delivering the information. With this process, the brain is able to regulate the body’s physiological processes including memory.

Dopamine, endorphins and serotonin are all forms of neurotransmitters, affecting mental health in different ways. While dopamine comes into play when one is enjoying activities, the endorphins produces feelings of pleasure. Conversely, one’s behavior or their mood depends on the serotonin levels. The disruption of the balance of these chemicals in the brain may alter mental health. Schizophrenia, for instance, is associated with the imbalance of the dopamine which also accounts for the attention deficit hyperactivity disorder (ADHD).

This is because the imbalance of the chemical reduces one’s motivation by reducing the reward that ADHD person experiences when they complete a task (Franco, Reyes-Resina, & Navarro, 2021). Similarly, the decline in level of serotonin may alter one’s mood, accounting for issues such as depression.

The Neurotransmitters I would address with her as it relates with her Depression

When it comes to depression, the neurotransmitter of interest is the serotonin, and I would focus on it to account for her symptoms of depression. People with extremely low serotonin levels tend to experience low moods or feelings of sadness. If a person becomes sad excessively or for long, this may result to depression. Because the neurotransmitter of interest is the serotonin, it is important to discuss with MS the medication that has the potential of helping increase the level of serotonin in her brain.

In discussion with MS these medications, it would be important to mention the Selective Serotonin Reuptake Inhibitors (SSRI). With the SSRI such as the Luvox, it is possible to increase the brain’s serotonin’s levels (Jiang et al., 2022). The discussion should also extend to other forms of support including the nutritional support which would cover foods with high serotonin content. Some of the foods to consider in this case include the spinach and nuts.

References

Franco, R., Reyes-Resina, I., & Navarro, G. (2021). Dopamine in Health and Disease: Much More Than a Neurotransmitter. Biomedicines, 9(2), 109. https://doi.org/10.3390/biomedicines9020109.

Jiang, Y., Zou, D., Li, Y., Gu, S., Dong, J., Ma, X., Xu, S., Wang, F., & Huang, J. H. (2022). Monoamine Neurotransmitters Control Basic Emotions and Affect Major Depressive Disorders. Pharmaceuticals (Basel, Switzerland), 15(10), 1203. https://doi.org/10.3390/ph15101203.

Teleanu, R. I., Niculescu, A. G., Roza, E., Vladâcenco, O., Grumezescu, A. M., & Teleanu, D. M. (2022). Neurotransmitters-Key Factors in Neurological and Neurodegenerative Disorders of the Central Nervous System. International journal of molecular sciences, 23(11), 5954. https://doi.org/10.3390/ijms23115954.

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