What is the diagnosis for a 17-year-old female with a progressively enlarging, pruritic rash on her left upper arm?

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Differential Diagnosis for Worsening Rash on Left Upper Arm

  • Single most likely diagnosis
    • Eczema (atopic dermatitis): The patient's symptoms of a worsening, itchy rash with a raised edge are consistent with eczema, a common skin condition characterized by inflammation and dryness. The lack of response to moisturizing creams does not rule out this diagnosis, as eczema can be resistant to topical treatments.
  • Other Likely diagnoses
    • Contact dermatitis: The rash's location on the upper arm and its itchy nature could suggest an allergic reaction to a substance that came into contact with the skin, such as a plant, metal, or chemical.
    • Psoriasis: The raised edge and growth of the rash could be indicative of psoriasis, an autoimmune condition that causes skin cells to build up and form scales.
    • Insect bite reaction: The itchy, raised nature of the rash could be a reaction to an insect bite, which can cause a localized skin reaction.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
    • Cellulitis: Although less likely, cellulitis is a bacterial skin infection that can cause redness, swelling, and warmth, and can be life-threatening if left untreated. The patient's symptoms of a growing, raised rash could be indicative of a more serious infection.
    • Lyme disease: The rash's appearance and growth could be consistent with erythema migrans, the characteristic rash of Lyme disease, which is caused by a tick-borne bacterial infection.
  • Rare diagnoses
    • Dermatofibroma: A rare, benign skin growth that can cause a raised, itchy rash.
    • Granuloma annulare: A rare skin condition characterized by a ring-shaped rash with a raised edge, which can be itchy and grow over time.
    • Cutaneous T-cell lymphoma: A rare type of skin cancer that can cause a variety of skin lesions, including itchy, raised rashes.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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