What additional assessment information should be obtained?

RB is a 27-year-old female who presents to the primary care clinic for evaluation of a rash on her right arm. Possible causes range from insect bites to smallpox, but most likely the problem will lie somewhere in the middle of that continuum. The differential diagnoses tick away in our heads as we begin our evaluation of RB. The rash is vesiculopapular, moderately erythematous and localized to the right forearm. There are excoriated areas indicating scratching due to itching. She reports that the rash started this weekend. The rash itches day and night. No other family members have a rash. She has never had a rash on her arms before. No one in the family has a history of asthma, allergies, or eczema. She reports no new soaps, perfumes, lotions, creams, detergents or other topical agents being used at home. You notice there are no burrows. The rash is in a linear distribution. Her activities this weekend included pulling weeds around the fence and trees in her yard. Her vitals are: blood pressure 123/74, respirations 20, pulse 68, and temperature 97.9.

Case Questions:

What additional assessment information should be obtained?
What are the differential diagnoses for this patient?
What management will be recommended for the patient?
What patient education should be included?

Sources should be within five years.

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