Case Study Lumps, Bumps, and Things That Go Itch in Your Of®ce!

This column includes a short case presentation and differential diagnosis. It is followed by a discussion of the disease or condition and how the school nurse should handle it. History A.W. is a 7-year-old male who comes to your of®ce because he wants you to look at his rash. He tells you the rash under his neck just started, and it is really bothering him today (Figure 1). You take a quick look and see a round, red, and raised lesion under his neck. You ask him if he has put anything on it and if it itches. He tells you it does not really itch but has been slightly painful today. He has not put anything on it today, but his mom has been putting some cream on his ``rashes,' ' however, it is not helping. You have sev-eral children waiting to be seen in the health of®ce. He does not look sick, so you ask him to wait. When you get back to him, you ask him how long he has had the rash. A.W. tells you the one on his neck just started, but he has had his other rash for at least 2 weeks. It seems to be spreading and getting worse. No one else in the family has a rash like his. You look at his health card and note that he has asthma, is al-lergic to tomatoes, and has a history of atopic der-matitis. He has not needed his inhaler this school year, and his immunizations are up-to-date. Physical Findings A.W. is a healthy-looking, slightly thin 7-year-old mixed race male child. He does not appear ill, and his vital signs are normal. You ask him where his rash is located, and he pulls off his shirt. You identify four lesions: one under his neck, one on his left shoulder, and two on his chest. The lesion over his left arm and his chest has a raised serpiginous advancing borde