PRIMARY CAREStories From the Field

Boosting Confidence in Urgent Care Dermatology

I work in a private urgent care setting where I independently manage a wide variety of acute and chronic skin conditions for a suburban population. Without instant feedback from an attending physician, I often turn to VisualDx to build differential diagnoses and reinforce my clinical reasoning. It’s been invaluable for confirming treatment plans for conditions like arthropod bites, poison ivy, tinea, and urticaria. I also appreciate the patient handouts that are easy to print and provide clear information to those who have additional questions.

For patients presenting with chronic skin conditions such as psoriasis, eczema, or rosacea, I’m able to offer guidance and treatment until they can see a dermatologist. Thanks to VisualDx, I’ve gained much more confidence in managing skin conditions that I might have otherwise deferred or mistreated without this wealth of knowledge at my fingertips.

—J.K, nurse practitioner

Differentiating Strep from Herpangina with VisualDx

I recently saw a patient who was concerned about strep after noticing white spots in the back of her throat. After observing ulcerations rather than exudate in her posterior oropharynx, I used VisualDx to confirm that she had herpangina, not strep. This allowed me to reassure her with confidence.

—F.H., Included Health physician

Spotting Lupus: From Sunburn Suspicions to SLE Diagnosis

A 38-year-old female presented with a chronic rash on the back of her neck and face, along with generalized fatigue. She worked as a lifeguard, and her rash worsened in the sun. Initially, I suspected sun-induced burns or drug-induced photosensitivity. However, despite my experience, I felt uneasy about the symptoms’ familiarity and decided to cross-check my thoughts using VisualDx.

To my surprise, VisualDx swiftly suggested systemic lupus erythematosus (SLE) as a likely diagnosis. The app highlighted the classic butterfly rash across the patient’s cheeks, along with her extreme fatigue, as indicative of this autoimmune disease. Lab work confirmed the diagnosis.

At her next appointment, we discussed the disease, treatment options, and follow-up care. I was also able to provide her with a patient information handout from VisualDx, summarizing our discussion, by sending it to the printer directly from my phone.

—C.B., Halifax Health attending physician

—A.V.O., Government House Clinic, Asaba, Delta State, Nigeria

From Hemangioma Guess to Pyogenic Granuloma Certainty

I had a patient with a month-long history of a lesion on his face that didn’t seem to bother him much. It resembled a hemangioma, but he was out of the typical age range for an infantile hemangioma. I initially sent him home with some general advice and a dermatology referral, but it nagged at me that I was so close to a diagnosis. Later, I input the case details into VisualDx. Within seconds, it helped me realize that my patient had a pyogenic granuloma and provided guidance on potential treatment options. I was able to follow up with the family with more precise information, much to their satisfaction.

—P.N., UNC Pediatrics at Cary physician

Identifying Tropical Dermatology Cases

I work in the Tropics, and my experience here has highlighted how little I know about recognizing eruptions on black skin. Occasionally, I encounter skin conditions that are typical of tropical regions. I find your images and diagnostic aids incredibly useful. For example, I once treated a 10-year-old girl who came in with a pustule at her waistband, which had a central black dot. She complained of feeling movement within the pustule. Thanks to VisualDx, I was able to identify and extricate a botfly.

—M.A., United States Embassy physician

From Uncertain Diagnosis to Life-Saving Surgery

A 6-year-old male presented with bilateral periorbital swelling for one week, which worsened after trauma to the forehead. A head CT revealed a lytic lesion concerning for Langerhans cell histiocytosis, potentially requiring a biopsy for confirmation. However, VisualDx suggested Pott puffy tumor—a complication of frontal sinusitis—as a differential diagnosis, which fit the clinical picture well. An MRI of the head subsequently showed frontal osteomyelitis with abscess, consistent with Pott’s puffy tumor. The patient underwent immediate surgery with abscess drainage. VisualDx helped broaden the differential diagnosis, leading to the accurate diagnosis and prompt treatment of a rare, life-threatening disease.

—C.C., IUSM medical student

Confirming Lichen Nitidus in a Pediatric Patient

A 3-year-old Hispanic boy was brought in by his mother for a linear rash on the back of his leg that had been present since birth and was becoming more noticeable. Despite trying various over-the-counter creams and consulting pediatricians, no diagnosis had been made. I used VisualDx to explore likely diagnoses and identified the rash as lichen nitidus. I showed the mother a picture of the condition and sent her an email link for further reassurance, helping to confirm that it was not a dangerous condition.

—S.R., AltaMed physician

Involving Patients in The Decision-Making Process

A 65-year-old African American male presented to my family medicine clinic with a 3-5 cm annular, hyperpigmented patch of leathery skin on his lower leg. It had developed over several weeks and was intermittently itchy but non-painful. At first glance, I was unsure of the diagnosis, as it was unlike anything I had seen before. To involve the patient in the diagnostic process, I used the VisualDx app in front of him. Upon selecting the ‘skin of color’ tab, we quickly identified the condition as lichen simplex chronicus. The app featured an image that matched his lesion exactly. His case was atypical because the lesion lacked scaling, so lichen simplex chronicus was not initially on my differential. Further questioning revealed that he had been using heavy emollients to treat the scale.

—B.S., Cone Health Family Practice medical student

Solving Complex Rashes with Organized Differential Diagnoses

As a provider, I often struggle to diagnose dermatologic findings during the brief snapshot of a patient visit. VisualDx has proven to be a valuable tool for gathering differential diagnoses in an organized way, with photographic references. For example, I had an elderly gentleman who presented with a severe diffuse rash that didn’t quite fit any known diagnosis in a straightforward manner. Using VisualDx, I was able to consider other immunologic, metabolic, and drug-induced causes, and the comparative images helped me differentiate from my patient’s presentation. I find this resource highly useful overall.

—E.T., A.T. Still University School of Osteopathic Medicine physician