Pruritus

Patient is 33-year-old female who is 23 weeks pregnant and approximately three and a half weeks ago erupted into this very itchy diffuse rash all over her body. She has been seeing Dr. for this who is her obstetrics physician. She has prescribed her prednisone 40 mg and this has resolved her rash significantly and reduced itching severely. She also has used multiple other medications including fish oil daily to help with itch. She has also been using a lidocaine spray although that seems to be drying out her skin, so she currently stopped that and is using Eucerin moisturizer to try to keep her skin moisturized. She has not had any problems with seasonal allergies in the past other than very mild symptoms. She has had some mild intermittent asthma in the past including mild-to-moderate wheezing episodes during or after exercise. She does get tightness in her chest on these occasions. It seems to be mostly in the fall that this occurs. She was hospitalized for this in 2008. She does have inhaler Flovent that she uses as needed. She seems to be triggered by strong smells. She has never needed prednisone for her wheezing episodes. She does complain of coughing spells, shortness of breath with exercise, coughing on exertion and coughing with laughing. She has not had a chest x-ray within the last five years. She did have asthma as a child. She denies any allergic skin problems until now and she has not been evaluated for allergies in the past.

She states that she has not changed anything environmentally in the home or switched to a different laundry detergent or used any other new soaps or shampoos since this rash has begun. Also it is not associated with exercise. She also has not changed any medication.

ASSESSMENT:
1. Pruritus.
2. Rash unspecified versus PUPPP versus atopic dermatitis.
3. Exercise-induced mild intermittent asthma triggered by smoke and strong fumes.
4. 23 weeks pregnant.

PLAN:
1. At this time, I encouraged her atopic dermatitis action plan as her skin appears to be very dry today and may help with the itching. I encouraged her to use Eucerin moisturizer and to pat dry after bathing and using lukewarm water. I also gave her samples of Olivamine lotion as well as Exederm with 1% hydrocortisone cream to help with some of her hotspots.
2. I prescribed her Zyrtec 10 mg one to two times daily to help resolve itching,
3. She will let us know if this is helping her itching complaints. I also encouraged her to try to taper off of prednisone in the next three days as this is a pregnancy category C medication and we would like to reduce the amount of prednisone she is given this reaction.

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