Keratosis pilaris

Patient is 35-year-old female who comes to discuss this rash that has been flaring and resolving for the last year and a half. It is mostly on her outer arms, upper arms and lower arms and on her thighs. She states that they are just a red pimple like bumps on each hair follicle. It does not hurt, itch or bother her too much although sometimes they get red and irritate and other times it does not depending on how often she uses lotions. She is concerned if this is associated with seasonal allergies, food allergies or other chemical product allergy.

She does state she has some chronic nasal symptoms including clear nasal discharge, postnasal drip, frequent nose blowing and heartburn. She uses Flonase for this daily and does provide some relief. She also uses Xyzal and Singulair and that does seem to help as well. It does seem to occur every day. She has tried Benadryl, Claritin, Zyrtec, Allegra and those have not worked as well. Currently her Xyzal, Flonase and Singulair seem to be the best thing for this providing good relief. She uses Flonase one spray each nostril in morning.

She denies any frequent sinus infection, nasal polyps, TMJ, frequent headaches, aspirin-induced nasal symptoms, nasal surgery, frequent bad cold, or frequent tonsillitis.

She denies any frequent ear infection, dizziness, lightheadedness or hearing impairment.

She denies any itching, redness or burning. She does admit having tearing and dryness. She denies light hurting her eyes, yellow discharge from eyes, eyelid swelling or eyelid irritation. This occurs a lot of the time.

She denies any history of wheezing or lung troubles. She did have diagnosed with exercise-induced bronchoconstriction as a child but she has kind of grown out of this. She no longer needs albuterol prior to exercise but is not exercising much lately. She has never needed steroid to help with any flare of asthma symptoms. She does admit having recurrent night cough, shortness of breath with exercise, coughing on exertion, coughing with lying down. She denies frequent coughing spells, coughing up mucus, blood in mucus, coughing with wheezing, coughing with laughing and coughing with talking on the phone. She has had recent a chest x-ray done in 2015 at Hospital.

She denies any history of allergic skin problems but just having this rash on her arms that bothers her. She has never been evaluated for allergies before.

ASSESSMENT:
1. Keratosis pilaris.
2. Allergic rhinitis.
3. Allergic conjunctivitis.
4. Concern for chemical allergy.

PLAN:
1. At this time, I talked to she that we do need to get her off of Xyzal and doxepin for two weeks time in order to pursue seasonal allergy testing. I do feel that this would be a good avenue for her so we can identify her allergens and then possibly do allergy immunotherapy to desensitize her.
2. I did talk to her about pursuing patch testing next week to identify any chemical allergies and we will do so and she will bring in a couple of her products as well so that we can test those and make sure she is not having a reaction to any of her chemical or metal.
3. I did talk to her that this is a very benign condition. Her rash appears to be keratosis pilaris to me. It can resolve with certain ointments or good skin hydration but may not heal completely. I did encourage her to use good moisturizer every day. I also prescribed to her Accutane cream 10% to apply to her arms daily to see if this helps resolve anything as well.
4. We will follow up on Monday to pursue patch testing and then schedule skin in testing in two weeks time from today which would be March 23, 2016 to pursue skin testing. I also encouraged her to continue using Flonase and Singulair at this time.

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