Phone Visit
Narrative: SPRUCE MESSAGE VISIT Date: 2026-03-23 Encounter: Photo review (images of affected areas sent by parent) via Spruce text message CC: Impetigo spots on arms and legs not fully clearing after initial antibiotic course, now worsening. HPI: Malcolm (age unknown) was previously diagnosed with impetigo affecting his legs and arms, which was treated with oral cephalexin. His impetigo appeared to develop in the context of underlying eczema. The lesions improved approximately 70% — scabbing over — but are now returning and itchy, with the parent noting he may be scratching them in his sleep. A complicating factor is that his sibling Hendricks shared Malcolm's prescription, potentially resulting in an inadequate dose or duration for both children. Malcolm's legs were reported to be breaking out more the following day (2026-03-24). Assessment: Impetigo with incomplete resolution, likely due to insufficient antibiotic course (shared prescription between siblings). Recurrence/worsening may be related to underlying eczema and scratching. Dr. Hobbs noted a longer antibiotic course and bleach baths would be needed. Plan: Dr. Hobbs indicated a longer antibiotic course and bleach baths were warranted, and committed to providing a written plan. A prescription was sent (received by parent on 2026-03-27). Dr. Hobbs also noted a patient handout was still owed. On 2026-03-24, Dr. Hobbs asked a clarifying question about whether the new leg lesions blanched with pressure (to rule out petechiae/purpura), though no follow-up response was documented. Medications: - Cephalexin Dose not specified; oral formulation used during prior course (prior treatment (shared between siblings, potentially inadequate)) - (Prescription sent — specific medication not documented in Spruce) Key clinical quotes: "ok, likely need a long course and some bleach baths" "let me get you a plan created and written down" "Do those fade if you push on them?" Source: Spruce conversation t_2BM55EMROF800