Diagnoses of the skin

Part 1

Stephanie is a 22-year-old woman who has always been healthy. She exercises regularly, eats a healthy diet, and plays hockey on her local women’s hockey league. About a week ago, her grandmother, whom she was very close to, passed away suddenly. This was very hard on Stephanie emotionally, especially since she now lives away from home and has not had the support of family during this difficult time. She has been trying to deal with the pain of her grandmother’s loss and still not miss any days at her job as a data analyst for an IT company.

To make matters worse, her skin has lately started to bother her. It’s January, which means that the air is dry, and when her skin starts to feel itchy she doesn’t think very much of it. She uses lotion religiously to try to keep the dryness down, but somehow it doesn’t seem to be helping. Finally, it becomes irritating enough that she makes an appointment to see her doctor.

When she describes her problems to her doctor, Dr. Shelby, Dr. Shelby asks to see the areas of her skin that are bothering her. Stephanie shows her some areas on her elbows and knees, as well as one on her back. The areas that are itching and kind of painful appear red and scaly, almost silvery in the center. They are round in appearance, almost like a rash, but are not bumpy and while Stephanie has had rashes before, they were never painful like these.


1. Name the four layers of the epidermis in the areas affected in Stephanie.

2. What is your diagnosis for Stephanie?

3. This disease has what are known as “underlying causes” as well as “triggers” that cause it to appear. What is thought to be the underlying cause of this disease – that is, why does Stephanie have it and not someone else?

4. Given Stephanie’s recent history, what do you think triggered the appearance of this disease?

5. What is happening in the epidermis in this disease? What layer of the epidermis is overactive? How do you know?

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