Description
1) 1-2 page, including introduction, purpose statement, and conclusion. Use clinical terminologies to explain the physical characteristics featured in the graphic. 2) Formulate a differential diagnosis of five possible conditions for the skin graphic that you chose (already chosen at the end of the attached file). 3) Determine which is most likely to be the correct diagnosis (Striae atrophicae) and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search (last 5 years with doi) and two different references from this week’s Learning Resources.Course references1)Bonifant, H., & Holloway, S. (2019). A review of the effects of ageing on skin integrity and wound healing. British Journal of Community Nursing, 24(Sup3), S28–S33. https://doi.org/10.12968/bjcn.2019.24.sup3.s282) Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby. —->attached pdf fileWrite the assignment under the attached SOAP file.please you DO NOT NEED to edit the soap note, just do the writing to determine the correct diagnosis supported by scholarly references. make sure to include the 2 references and the book chapter that I provided.
Unformatted Attachment Preview
Week 4
Skin Comprehensive SOAP Note Template
Patient Initials: _MN___
Age: 35____
Gender: Female_______
SUBJECTIVE DATA:
Chief Complaint (CC): Picture 2. Concern regarding the appearance of stretch
marks on the abdomen.
History of Present Illness (HPI): The patient is a 35-year-old female who
presents with a chief complaint of concern regarding the appearance of stretch
marks on the abdomen and breasts. The patient reports that these marks initially
developed during a period of rapid weight gain, specifically during pregnancy
approximately 5 years ago. The patient describes the initial appearance of the
stretch marks as reddish-purple lines on the abdomen and breasts, which have
since faded to a lighter color. The patient denies experiencing any associated
pain, itching, or other symptoms related to the stretch marks. The appearance of
the marks has remained the same. The patient notes that attempts to mitigate
the appearance of stretch marks through over-the-counter remedies have been
unsuccessful. The patient has not sought prior medical attention for the stretch
marks and is seeking evaluation for cosmetic concerns and information on
potential treatment options. The patient reported no relevant family history or
additional medical issues related to the chief complaint.
Medications:
1) Vitamin D3 50 mcg daily.
2) Atorvastatin 10mg daily.
Allergies:
No known allergies
Past Medical History (PMH):
1) Vitamin D deficiency.
2) Hyperlipidemia.
Past Surgical History (PSH):
1) Cesarean section 2018.
Sexual/Reproductive History:
Heterosexual
Personal/Social History:
Married
Number of Children: One, born in 2018
© 2021 Walden University
Page 1 of 4
Never smoked
Lives with her husband
Works as a social worker in a nearby hospital.
Health Maintenance:
Schedules routine check-ups with healthcare professionals
Engages in regular physical activity
Schedules regular eye/dental exams
Adheres to medication regimen
Immunization History:
Covid Vaccine #1 1/5/2021 #2 2/22/2021 Pfizer
Influenza Vaccination 10/3/20223
Tdap 8/22/2018
Significant Family History:
Father – with stroke in 2016
Mother – with diabetes dx at age 40
Two healthy living younger sisters.
Review of Systems:
General: No complaints of fatigue, weakness, or unexplained weight loss.
HEENT: The head is normocephalic and atraumatic, with no tenderness or
palpable masses. In the eyes, pupils are equal, round, and reactive to light,
extraocular movements are intact, and the conjunctiva is clear with a white
sclera. The ears show a normal external appearance, intact and pearly
gray tympanic membranes, and no reported pain or discharge. The nose
exhibits pink and moist nasal mucosa, a midline septum, and no discharge
or tenderness. Throat examination reveals a clear oropharynx, moist
mucous membranes, and normal tonsils, with no erythema, exudate, or
lesions.
Respiratory: denies cough, denied hemoptysis, no difficulty
breathing at rest; no dyspnea on exertion.
Cardiovascular/Peripheral Vascular: denies chest discomfort,
palpitations, or a history of murmurs. No reported or documented history of
arrhythmias, orthopnea, paroxysmal nocturnal dyspnea, edema, or
claudication.
Gastrointestinal: denies nausea or vomiting, with well-controlled reflux.
No reported abdominal pain; no alterations in bowel or bladder patterns.
© 2021 Walden University
Page 2 of 4
Incorporates fiber into their daily regimen as a laxative to prevent
constipation proactively.
Genitourinary: denies change in her urinary pattern, dysuria, or
incontinence.
Musculoskeletal: denies arthralgia or myalgia and reports no arthritis,
gout, or limitations in range of motion. Denies history of trauma or
fractures.
Neurological: denies neurological problems, including headaches,
dizziness, seizures, numbness, or tingling. Denies any recent changes in
cognition, memory, or speech.
Psychiatric: denies any psychiatric problems, including changes in mood,
anxiety, depression, or disturbances in sleep patterns. Reports no recent
episodes of panic attacks or suicidal thoughts.
Skin/hair/nails: denies any issues with the skin, hair, or nails, excluding
the presence of stretch marks on the abdomen. No complaints of itching,
pain, or changes in skin texture were reported.
OBJECTIVE DATA:
Physical Exam:
Vital signs: B/P 121/78, right arm, sitting, regular cuff; P 77 and regular; T 97.6
temporally; RR 18; non-labored; Wt: 140 lbs; Ht: 5’1; BMI 26.5
General: A/O x4, well-nourished, no acute distress; No signs of pallor, jaundice,
or cyanosis observed.
HEENT: normocephalic and atraumatic; no tenderness or palpable masses;
PERRLA; EOMI; normal appearance of ears, no pain or discharge; pink and
moist nasal mucosa, a midline septum, and no discharge or tenderness; clear
oropharynx, moist mucous membranes, and normal tonsils, with no erythema,
exudate, or lesions.
Neck: palpable carotids; no bruits; no JVD, no tenderness or thyromegaly
Chest/Lungs: Clear breath sounds throughout lung fields; normal respiratory
rate of 18 breaths per minute; symmetrical chest wall expansion; no use of
accessory muscles,
Heart/Peripheral Vascular: RRR, no murmur, rubs, or galops; S1 S2; +2
bilateral pedal and radial pulses.
Abdomen: Bowel sounds are present in all quadrants, soft, non-tender upon
gentle pressure; symmetrical with no visible signs of distension, discoloration, or
abnormalities; skin is intact, with no lesions or rashes noted; brownish color
striae noted.
© 2021 Walden University
Page 3 of 4
Genital/Rectal: The patient declined this exam.
Musculoskeletal: 5/5 strength in upper and lower extremities; full ROM in all
extremities; normal curvature of the cervical, thoracic, and lumbar spine.
Neurological: Cranial nerves II – XII grossly intact; DTR’s intact; +2 bilateral
reflexes; Steady gait.
Skin: Skin normal color, texture and turgor with no lesions or eruptions.
Diagnostic results:
No diagnostic tests were ordered.
ASSESSMENT:
Differential Diagnosis (DDx):
1) Skin rash
2) Purpura
3) Morphea
4) Linear Scleroderma
5) Ecchymosis
Primary Diagnoses:
1) Striae atrophicae
PLAN: This section is not required for the assignments in this course (NURS 6512), but
will be required for future courses.
© 2021 Walden University
Page 4 of 4
CHAPTER 28
Rashes and skin lesions
Dermatologic problems result from a number of mechanisms, including inflammatory, infectious, immunologic,
and environmental (traumatic and exposure induced). At times, the mechanism may be readily identified, such
as the infectious bacterial etiology in impetigo. However, some dermatologic lesions may be classified in more
than one way. Most insect bites, for example, involve both environmental (the bite) and inflammatory (the
response) mechanisms. Awareness of the potential mechanism of any skin disorder is most helpful in
identifying the risk a person may have for other illnesses. For example, people with eczema are also frequently
at risk for other atopic conditions, notably asthma and allergic rhinitis. Thousands of skin disorders have been
described, but only a small number account for the majority of patient visits.
Evaluation of rashes and skin lesions depends on a carefully focused history and physical examination. The
provider needs to be familiar with the characteristics of various skin lesions; anatomy, physiology, and
pathophysiology of the skin; clinical appearance of the basic lesion; arrangement and distribution of the lesion;
and associated pathological conditions. It is also important to know common symptoms associated with specific
lesions such as itching or fever. It is necessary to quickly identify life-threatening diseases and those that are
highly contagious. Ultimately, competence in dermatologic assessment involves recognition through repetition.
Diagnostic reasoning: Initial focused physical examination
Initial inspection
Dermatologic assessment is similar to the assessment of most other body systems in that it depends on patient
history and physical assessment. However, sometimes a brief physical assessment preceding the history can
assist in the development of the initial differential diagnoses followed by a focused history and further physical
examination.
Morphologic criteria
Examination involves the classification of the lesion based on a number of morphologic features (examples are
listed in Tables 28.1 and 28.2 and illustrated in Figs. 28.1 and 28.2). Evaluation should be systematic. Generally,
morphologic features should be analyzed as follows:
• Identify the location of the lesion(s).
• Identify the distribution of the lesions as localized, regional, or generalized.
• Identify whether the lesion is primary (appearing initially) or secondary (resulting from a change in a
primary lesion).
• Identify the shape of the lesion and any arrangement if numerous lesions are present.
• Assess the margins (borders).
• Assess the pigmentation, including variations.
• Palpate to assess texture and consistency.
• Measure the size of an individual lesion or estimate the size if lesions are numerous or widespread.
6/7/2019
FIGURE 28.1 Types of skin lesions. Source: (From, Ball JW, Dains JE, Flynn J, et al: Seidel’s guide to
physical examination, ed. 8, St. Louis, 2015, Elsevier.)
6/7/2019
FIGURE 28.2 Typical distribution of papulosquamous eruptions in children. A, Atopic dermatitis:
usually located on the cheeks, creases of elbows, and knees. B, Seborrheic dermatitis: usually
located on the scalp, behind the ears, in thigh creases, and in eyebrows. C, Scabies: usually
located on the axillae, webs of fingers and toes, and intragluteal area. Source: (From Berkowitz C:
Pediatrics: A primary care approach, ed. 2, Philadelphia, 2000, Saunders.)
6/7/2019
Table 28.1
Morphologic Criteria of Rashes and Skin Lesions
NATURE OF
LESION
DESCRIPTION
EXAMPLES
PRIMARY LESIONS (DEVELOP INITIALLY IN RESPONSE TO CHANGE IN INTERNAL OR
EXTERNAL ENVIRONMENT OF SKIN)
Macule
Discrete flat change in color of skin; usually
1.5-cm diameter
Pityriasis rosea, melasma, lentigo
Papule
Discrete palpable elevation of skin; 1-cm diameter; scaling frequently
present
Psoriasis, mycosis fungoides
Wheal
Transient pink/red swelling of skin; often
displaying central clearing; various shapes
and sizes; usually pruritic and lasts 1-cm
diameter
Basal cell carcinoma, squamous cell
carcinoma, malignant melanoma
Pustule
Raised lesion 50–100), and atypical moles as
designated by biopsy. Other factors that increase the risk of melanoma include adulthood, blond or red hair,
blue or lightcolored eyes, changed or persistently changing mole, white race, fair complexion, freckles, personal
history of melanoma, immunosuppression, inability to tan, severe sunburns in childhood, and presence of a
congenital mole. In addition, UV light from tanning beds can both cause melanoma and increase the risk of a
benign mole progressing to melanoma.
Basal cell carcinoma
Basal cell carcinoma usually appears as a small, fleshy bump or nodule on the head, neck, or hands.
Occasionally, these nodules may appear on the trunk of the body, usually as flat growths. These basal cell
tumors do not spread quickly. It may take many months or years for one to reach a diameter of 1/2 inch.
Untreated, the carcinoma will begin to bleed, crust over, and then repeat the cycle. Although this type of cancer
rarely spreads to other parts of the body, it can extend below the skin and cause considerable local damage. The
cure rate for basal cell carcinoma (sometimes referred to as nonmelanoma carcinoma) is 95% when properly
treated.
Squamous cell carcinoma
Squamous cell carcinoma presents as an indurated papule, plaque, or nodule with a thick scale that is often
eroded, crusted, or ulcerated. It can be found on sunexposed skin surfaces, in areas of radiodermatitis, or on
old burn scars. Although slow growing, squamous cell carcinomas arising on the lip, mouth, or ears may be
associated with regional lymphadenopathy and metastasis. If promptly and properly treated, it has a cure rate
of 95%.
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0028-print-1559929397.xhtml
6/7/2019
DIFFERENTIAL DIAGNOSIS OF Common Causes of Rashes and Skin Lesions
CONDITION
CHARACTERISTICS
DISTRIBUTION
OR
PROGRESSION
ASSOCIATIONS
DIAGNOSTIC
STUDIES
FOLLICULAR ERUPTIONS
Acne vulgaris
Comedones and/or
papules, pustules, cysts
Face, neck, back,
chest, upper
arms
Onset of puberty,
topical steroids,
anabolic steroids,
systemic
corticosteroids,
lithium, phenytoin
Usually none
Rosacea
Flushing, persistent
redness, sebaceous
hyperplasia,
erythematous papules,
telangiectasias, ocular
involvement in up to
40%
Symmetrical,
usually face
only; may
involve eyes
Topical steroids,
systemic
corticosteroids
Usually none
Bacterial
culture
INFECTIOUS ERUPTIONS
Impetigo
Vesicular infection; honey
colored crusts and
erosions
Face; any area of
body with a
minor wound,
especially
excoriated
lesions
Scratching as a result of
insect bites, atopic
dermatitis, scabies
Folliculitis
Superficial perifollicular
papules and pustules
Any hairbearing
body surface,
but especially
scalp, beard,
legs, axillae
Shaving, hot tubs,
Bacterial
contact with mineral
culture
oils, occlusive
dressings
Furuncle
Very tender, deepseated
inflammatory nodule
that develops from
folliculitis
Same as folliculitis
May have fever
Incision and
drainage for
bacterial
culture
Carbuncle
Multiple coalescing
furuncles
Same as furuncle
Same as furuncle
Same as
furuncle
MACULAR OR PAPULAR ERUPTIONS
Erythema
infectiosum
Brightred rash or
“slapped cheeks,”
followed by diffuse
maculopapular rash on
trunk and extremities,
leading to a lacy
appearance as
exanthem fades
Cheeks, then trunk Aplastic anemia in
children with
and extremities
underlying
hemolytic anemias;
fetal hydrops has
been reported in
pregnant women
infected with
parvovirus B19
IgM, IgG can be
measured
Measles
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0028-print-1559929397.xhtml
6/7/2019
CONDITION
CHARACTERISTICS
DISTRIBUTION
OR
PROGRESSION
ASSOCIATIONS
DIAGNOSTIC
STUDIES
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0028-print-1559929397.xhtml
6/7/2019
Patient develops three Rash starts on neck and
Cs: cough, coryza,
ears faintly, then
and conjunctivitis;
covers face, arms, and
Koplik spots are
chest; on second day
evident on buccal
rash covers lower
mucosa; rash
torso and legs; on
begins with spike
third day rash is on
of convalescent
feet and face; rash
fever; rash is
begins to fade on the
centripetal in
fourth day
distribution,
possibly becoming
hemorrhagic in
severe cases
Abdominal pain, otitis IgM can be
media, and
measured for
bronchopneumonia
measles as
are commonly
well as acute
associated; severe
and IgG
cases can cause
titers
encephalomyelitis
Rubella
Tender
Rash begins on face and
lymphadenopathy
spreads to trunk and
of postauricular,
extremities within
posterior occipital
first 24 hr
nodes;
maculopapular
and confluent rash
that is lacy and not
pruritic; rash lasts
3 days
Infection with virus
while pregnant
results in
congenital rubella
Confirmation by
acute and
convalescent
IgG titers, or
by direct
measurement
of rubella
IgM
antibody
Pityriasis
rosea
Multiple oval
Trunk, proximal
erythematous
extremities, rarely on
lesions with an
face; rash is preceded
inner fine circle of
by a “herald patch,”
scale; ovals line up
appearing from a few
along skin
days to 3 wk before
cleavage lines on
generalized eruption
trunk, producing a
Christmas tree
–like pattern
More common in
spring and fall
If present on
palms and/or
soles and
history
warrants,
check RPR to
rule out
secondary
syphilis
Scarlet
fever
Fine, mildly
erythematous
papules and
sandpaperlike
rash found on
trunk
Strawberry tongue;
Pastia lines: areas
of linear
hyperpigmentation
in deep creases
Culture for
group A
streptococci
Roseola
High fever for 3–4
Rash begins on trunk and Posterior cervical
lymphadenopathy
days in infants and
quickly spreads to
young children; as
arms, face, neck, and
fever returns to
legs
normal, a diffuse
maculopapular
rash erupts
Rash begins in axillae,
groin, and neck; it
avoids face, but there
is circumoral pallor
None
VESICULAR AND BULLOUS ERUPTIONS
None
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0028-print-1559929469.xhtml
6/7/2019
Hand,
foot,
and
mouth
disease
Painful mouth ulcers
followed in 24 hr by
painful vesicles on
fingers, palms, toes,
and soles
Lowgrade fever, sore
throat, and
malaise; cervical
and
submandibular
lymphadenopathy
possible
Insect bites Flea, tick bites most
Lower legs, but may
common; intensely
appear anywhere on
pruritic eruption,
body if pets allowed
usually in groups
on furniture or beds
of three; bull’seye
rash
Exposure to dogs or
cats, or to carpeted
areas previously in
contact with
infected animals;
outdoor exposure
Confirmatory
biopsy
occasionally
needed
Travel, sleeping in a
different bed
Observe
environment
for bugs,
stains;
implement
eradication
measures
Primary infection
Herpes
Other STIs, HIV;
Can occur anywhere on
with grouped
simplex
triggered by sun,
body, but most
vesicles on an
virus
stress, fatigue,
common areas are
erythematous base
fever, trauma
genitals, thighs,
at site of
mouth, lips, and chin;
inoculation;
may be disseminated
regional
in patients who are
lymphadenopathy;
immunocompromised
may be preceded
by prodrome of
tingling, itching,
burning, or
tenderness
Viral culture
Tzanck
smear; screen
for STIs, HIV
if history
warrants
Herpes
zoster
Viral culture,
Tzanck
smear
Bed bugs
Systemic illness
caused by
coxsackievirus
A16; painful white
vesicles with
surrounding red
halo
Bites may be present,
examine bed for
small reddish
brown spots
General distribution
Unilateral pain,
Can occur anywhere on
itching, or burning
body but is unilateral,
preceded by 3–5
following a
days of eruption of
dermatomal pattern;
vesicles or bullae;
requires prompt
followed by
referral to
crusting and
ophthalmologist if
erosions
eye involved (Note:
See lesion on tip or
side of nose for
indication.)
Immunosuppression,
older age, local
trauma in children
Varicella
zoster
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0028-print-1559929469.xhtml
6/7/2019
Generalized pruritic
vesicular lesions
that are in
different stages of
healing;
erythematous
vesicles, ruptured
vesicles, and
crusted vesicles
with scabs
Lesions usually
begin on
trunk and
spread to
face and
proximal
extremities
Herpes zoster occurs with
reactivation of virus
ELISA titers can
confirm
acute
infection
Diaper area in
infants, body
folds,
mucosal
surfaces,
nails, and
nail folds
Immunocompromised,
diabetes, steroid
inhalants, pregnancy,
oral contraceptives,
antibiotics, systemic
and topical steroids
KOH, culture
FUNGAL INFECTIONS
Candidiasis
Beefyred, well
demarcated
plaques, often
with scaling edge
and satellite
lesions;
intertriginous
areas may also
show erosions and
maceration
Tinea
Variable, depending
Skin, hair, feet,
on body part
nails
affected; hair:
scaling, hair loss,
pustules; skin: red,
scaly patch that
may develop
central clearing;
feet: vesicles or
bullae
Immunocompromised,
KOH, culture
systemic corticosteroids,
farmers and others with
animal contact, hot
humid weather with
tight clothing or
occlusive footwear
Pityriasis
(tinea)
versicolor
Variably colored
Upper trunk,
white to pink to
axillae, neck,
brown scaling,
upper arms,
round or oval
abdomen,
macules of
thighs,
varying sizes;
genitals
often coalescing to
form large areas of
discoloration
Heat, humidity, tropical
KOH shows
climates, exercise,
hyphae and
systemic corticosteroids,
spores in
seborrheic dermatitis
“spaghetti
and
meatballs”
pattern
IMMUNOLOGIC OR INFLAMMATORY ERUPTIONS
Eczema or
atopic
dermatitis
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0028-print-1559937554.xhtml
6/7/2019
Erythema,
papules,
vesicles,
scaling,
excoriations,
crusts, pruritus
always present
Symmetrical; infant: Personal or family
Serum IgE;
face, flexures;
history of asthma,
culture for
children: flexural
seasonal allergies, and
bacteria or
creases; adults:
eczema; secondary
HSV if
may be discrete
colonization with
indicated
round patches or
Staphylococcus aureus
be regionalized
or HSV
to specific area
Contact or
allergic
dermatitis
Vesicles and
erosions with
edema and
inflammation,
giving way to
crusts and
lichenification;
pruritus
Localized, often
asymmetrical;
may be
generalized with
airborne
allergens or
poison ivy;
linear pattern
with plant
dermatitis
Occupational,
recreational pursuits
Patch testing
Psoriasis
Welldemarcated,
hamcolored
plaques and
papules with
silvery scale;
chronic,
recurrent
pruritus is
common
Favors elbows and
knees, scalp;
intertriginous
areas may
involve nails
Streptococcal infection,
arthritis, HIV
infection,
medications, alcohol,
family history
ASO titer or
strep culture
if indicated;
HIV if
indicated;
biopsy
Seborrheic
dermatitis
Chronic scaling,
flaking,
erythematous
dermatitis;
variable
pruritus
Areas where
sebaceous
glands are most
active: face,
scalp, eyebrows,
eyelashes, body
folds, ear folds,
presternal area,
mid and upper
back, genitalia
Atopic history, HIV
infection
HIV if indicated
Begins on upper
extremities and
trunk
Herpesvirus, Mycoplasma
pneumoniae infections,
drugs (especially
sulfonamides)
Skin biopsy may
assist in
diagnosis;
chest film for
Mycoplasma
Transient wheals
Localized, regional,
that may be
or generalized
acute or
chronic (lasting
>6 wk);
Angioedema may also be
present, may be life
threatening; chronic
infection, SLE,
lymphoma
Biopsy; general
medical
workup to
rule out
underlying
ALLERGIC REACTIONS
Erythema
Hypersensitivity
multiforme
reaction seen
as annular
target or iris
lesions
Urticaria
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0028-print-1559937911.xhtml
6/7/2019
individual
lesions tend to
come and go
within hours;
pruritic
systemic
disease in
chronic
urticaria
NEOPLASTIC ERUPTIONS
Malignant
melanoma
Asymmetrical
border,
irregular, has
color variation
within lesion
and is >6 mm
Anywhere on body,
including scalp
Usually asymptomatic,
unless bleeding,
ulceration, discharge
present
Basal cell
carcinoma
Papular or
nodular
lesions, with
raised pearly
borders, and
numerous
superficial
telangiectases
Sundamaged areas; Usually asymptomatic
also seen in
covered areas
when there is
genetic
predisposition to
basal cell
carcinoma
Squamous cell
carcinoma
Indurated papule, Sundamaged areas,
plaque, or
areas of
nodule; may be
radiodermatitis,
eroded,
old burn scars;
crusted, or
can occur
ulcerated
anywhere on
body
Skin biopsy,
excisional
biopsy
Skin biopsy
Usually asymptomatic;
Skin biopsy,
can be associated with
excisional
HPV,
biopsy
immunosuppression,
topical nitrogen
mustard, oral PUVA,
chronic ulcers,
industrial
carcinogens, arsenic
ELISA, enzyme-linked immunosorbent assay; HIV, human immunodeficiency virus; HPV, human papillomavirus; HSV,
herpes simplex virus; IgG, immunoglobulin G; IgM, immunoglobulin M; KOH, potassium hydroxide; PUVA, psoralen plus
ultraviolet A (light therapy); RPR, rapid plasma regain; SLE, systemic lupus erythematosus; STI, sexually transmitted
infection.
http://e.pub/isc9kypqjl4sstrvk47e.vbk/OEBPS/xhtml/CHP0028-print-1559937911.xhtml
6/7/2019
Purchase answer to see full
attachment
