FY2 in the GP surgery
18 yr old woman
Presented with concerns
Talk to the patient and address concerns
Opening sentence “Doctor, I have got an embarrassing problem”, “I have a rash in the groin”
Questions
- Is it contagious?
- What caused it?
Approach
GRIPS
- History of rash
- Where is the rash?
- How many rashes?
- How did the rash start?
- Is it rash or spots?
- What is colour?
- Is there any bleeding?
- Any pus?
- Any pain?
- Any itching?
- When did the rash start?
- Has the rash spread anywhere?
- Has it happened before?
Differential diagnosis
- Allergic reaction
- Contact dermatitis
- Post-waxing irritation
- STI (herpes infection)
Ask about
- Using new soaps
- New lotions?
- New clothes or tuderwear?
ICE
Idea
- Have you thought of anything that could be the cause?
- Did you do anything unusual a few days before the rashes started?
- Anything out of ordinary that you did recently
Concerns: Worries, is there anything that worries you the most?
Waxing
- Any shaving in your groin?
- Any waxing?
- What type of waxing?
- What areas did you wax?
- Do you feel this could be the cause?
Other history
- Sexual history: Stable relationship, safe sex, STI symptoms, rashes anywhere else
- PMAFTOSA
- Effects of symptoms
Examination
- Rashes
- Lymph nodes
Diagnosis
- Superficial folliculitis as a result of waxing
- Inflammation of hair follicles
- Advice to avoid scratching
- Usually rheals without scarring
Management
- Apply warm, wet compressors
- Avoid tight underwear
- Wear cotton underwear
- Apply salicylic acid on the waxed areas
- Leaflet about folliculitis
- Topical antiseptic - To prevent/treat bacterial infection
- Stop waxing for sometime (around 3 months)