Differential Diagnosis for the 14-year-old boy with a mildly pruritic rash
- Single most likely diagnosis:
- Tinea corporis (ringworm) - This is the most likely diagnosis given the patient's occupation as a wrestler, which increases the risk of skin-to-skin contact and fungal infections. The location and description of the lesion are also consistent with tinea corporis.
- Other Likely diagnoses:
- Contact dermatitis - The patient's participation in sports and exposure to various environmental factors on the farm could lead to contact dermatitis.
- Impetigo - Although less likely given the description of the lesion, impetigo is a common skin infection in children and could be considered, especially if the lesion is weeping or crusted.
- Eczema (atopic dermatitis) - The patient's history of mild asthma increases the likelihood of atopic dermatitis, which could present with pruritic lesions.
- Do Not Miss diagnoses:
- Cellulitis - Although the patient's temperature is normal, and the lesion is described as mildly pruritic, cellulitis is a serious bacterial infection that requires prompt treatment. It would be unusual for cellulitis to present with a single, well-defined lesion, but it should be considered if the patient's condition worsens or if there are signs of systemic infection.
- Lyme disease - Given the patient's exposure to the outdoors and potential tick bites, Lyme disease should be considered, especially if the lesion has a characteristic "bull's-eye" appearance.
- Rare diagnoses:
- Leishmaniasis - This parasitic infection is rare in North Dakota but could be considered if the patient has traveled to endemic areas.
- Sporotrichosis - This fungal infection is rare but could be considered given the patient's exposure to soil and plants on the farm.
- Cutaneous larva migrans - This parasitic infection is rare but could be considered if the patient has exposure to contaminated soil or animals.