Are there any obvious factors which trigger or exacerbate the problem? Possibilities include: Sunlight
Extremes of temperature (itching is often worsened by heat) Contact with certain substances (e.g.
latex, rubber, metals, hair dye) Work (e.g. occupational allergy or wet work leading to irritant contact
dermatitis).
Does anything relieve the symptoms? e.g. sunlight, topical treatments, systemic drugs.
Are there any systemic symptoms such as fever, malaise, joint pain, weight loss, or sore throat?
Past medical history Previous skin problems? Ask also about diabetes, connective tissue disease,
inflammatory bowel disease, atopy (eczema, especially as a baby, asthma, hayfever)?
Allergies Remember to ask about the nature of any allergic reaction claimed.
Drug history Which drugs is the patient taking and for how long? See Box 4. .
If a drug reaction is possible, ask about recent courses of drugs not taken regularly (e.g. antibiotics,
over-the-counter analgesics).
Bear in mind that there may be a delay of a few days to months before a drug eruption occurs
Immunosuppression can increase the risk of skin cancer.
Family history
Ask especially about atopic diseases, psoriasis, skin cancer.
Social history
Hobbies.
Insect bites?
Risk factors for sexually transmitted diseases? Take a full sexual history if relevant. 0 Be delicate.
Psychosocial impact
Physical symptoms such as pain or worsening in sunlight might curtail usual activities.
1. Are you ever short of breath? Has this come on suddenly?Pulmonary embolism
7. Do you snoreloudly? Do you fallasleep easily during the day? When? Have you fallen asleep while
driving?(Sleep history)
13. Have you had any bleeding or dischargefromyour breasts or feltany lumps there? Carcinoma ofthe
breast
Gastrointestinal system
10. Have you seen blood in your motions or vomited blood?Gastrointestinal bleeding