Dermatological history

Introduction

Introduce yourself, stress confidentiality and gain consent to take a history from the
patient

Name, age, occupation (contact dermatitis may be caused by chemicals or products used
at work)

Presenting Complaint (PC)

Open questions:

What seems to be the problem today?

Can you describe your skin problem?

History of Presenting Complaint (HPC)

When did it start?

How did it start?

Where did it start?

Has it changed over time?

Where is it now?

Is anywhere else? (spread/distribution)

What does it feel like? Color- flat- raised

Does anything make it better or worse? Eg sunlight-stress- trauma- allergen-contact

Experienced this before?

Symptoms

Itch

Pain

Bleeding

Discharge

Blisters

Systemic symptoms

Any treatment used? (This can help when formulating a treatment plan. You don't want to
give the patient something that they are not keen to try again. Perhaps they have been
using herbal remedies too.)

Contact history - scabies, chickenpox (contagious conditions)

Noticed any problems with your mouth, nails, joints, scalp or hair? (Lichen Planus can
cause white streaks in the mouth called Wickham's striae and ulcers arise in Behcet
Disease. Psoriasis can cause arthritis and nail changes such as pitting.)

How do you feel otherwise? A systematic review could be used here as the presence of
pyrexia and malaise are important. Many systemic disease have associated skin
conditions - diabetes mellitus and Crohn's disease- respiratory

Past Medical History (PMH)

How is your general health?

Previous skin condition?

Asthma, hayfever or eczema? (Signs of atopy)

RA- celiac D

Family History (FH)

Eczema

Hayfever

Asthma

Psoriasis

Skin cancers

Drug History (DH)

Current medications and length of use (Some medications can cause skin reactions. For
example the pill can cause erythema nodosum)

Allergies

Skin reactions - nickel (some jewellery contains nickel which can cause a contact
dermatitis)

Use any cosmetics or moisturising creams?

Travel History (TH)

Where do you come from?

Been abroad recently?

A lot of sun exposure?

Use any suncream - what factor?

What does your skin do in the sun? - burn, tan easily

Social History (SH)

Alcohol

Smoking

Home situation - who's there, support available

Changes - washing powder, pet (may aggravate skin conditions)

Hobbies - gardening (In America plants such as poison ivy can commonly cause a contact
dermatitis)

Any stressful events - stress can precipitate skin conditions

Job > Does the problem improve when away from work/hobbies?

Sexual History

Current relationship status - sexually active?

Any symptoms down below - pain, discharge, skin changes?

Does their partner have any symptoms?

Use of condom?

How is this skin problem affecting your day to day life?

Ideas, Concerns and Expectations (ICE)

What do you think may be causing this skin problem?

Any particular concerns/worries?

Summarise
Examination
Use a systematic approach to the skin lesions:
Distribution >
Localized or generalized?
Symmetrical? If so, are the lesions peripheral (e.g. lichen planus) or
central (e.g. pityriasis versicolor)?
Do skin lesions involve the flexures (e.g. eczema) or extensor
surfaces (e.g. psoriasis)
Are lesions limited to sun-exposed areas?
Are lesions linear or ring-shaped?
Is the distribution dermatomal e.g. shingles?
Does the problem affect only one region e.g. axilla, face, groin, foot?
Individual lesion morphology A magnifying hand lens is often helpful in
looking at individual lesions. Palpation is also important to determine
consistency, depth, and texture.
Are lesions monomorphic (take one forme.g. guttate psoriasis) or
pleomorphic (take many formse.g. chickenpox)?
Are there s changes on top of primary lesions, e.g. excoriations?
How are lesions grouped locally, i.e. ring-shaped, linear, Koebner
phenomenon?
Check hair, nails, and mucous membranes
Consider general examination If examination of the skin suggests
systemic cause.