You are the Hospitalist APRN who is

You are the Hospitalist APRN who is spearheading a new program of “Skin Rounds”. After identifying an unacceptably high number or pressure ulcers at University Hospital you created a program involving a multi-disciplinary team that rounds on all patients in the hospital once a week to identify potential and actual integumentary system problems including pressure ulcers, wounds and infections. Today you are rounding in the ICU when Steve, the RN caring for a 46 year old obese, intubated and sedated patient being treated for community acquired pneumonia. Steve is concerned about a “rash” that he found while caring for his patient. On your exam you note an erythematous, macular rash on the intertriginous areas of the patient’s bilateral groin. It has an abraded appearance with some lichenified areas. The patient is obese and you note that due to large skin folds the groin is moist. Prior to intubation the patient had complained to his nurse of pruritis in the area and had mumbled something under his breath about an unfaithful sexual partner. His past medical history is notable for tobacco use, tinea pedis, and asthma. After considering the above case please give your top three differentials in order of likelihood.

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