Derm history taking

Question 1

List some of the main skin diseases in the UK?(9)

Answer 1

• Skin cancer (including melanoma)
• Acne
• Actopic eczema
• Psoriasis
• Viral warts
• Other infective skin conditions
• Benign tumours and vascular lesions
• leg ulceration
• Contact dermatitis and other eczemas

Question 2

List/appreciate some of the causes of skin disease (9)

Answer 2

• Irritants
• Genetic factors
• Sunshine
• Allergens
• Temp/humidity
• Infections
• Drugs
• Internal disease
• Psychological factors

The cause of skin disease is often multifactorial

Question 3

What should you make sure you ask about in the history of presenting complaint ?

Answer 3

1. Duration
2. Site and appearance at onset
3. Details of evolution / spread
4. Symptoms – itch, pain, burning
5. Aggravating or relieving factors
6. How does the condition affect you?

Question 4

What should you be asking about for a systemic enquiry relating to skin ?

Answer 4

• Itch (generalised, localised, with or without rash)
• Pain/burning/stinging (or other skin discomfort)
• Skin colour change
• Rash
• Lumps
• Swellings
• Mouth/tongue
• Eyes
• Lymph gland swellings
• weight changes
• hair
• nails

Question 5

What should you ask about in past medical history ?

Answer 5

• Previous skin disease - Atopy e.g. eczema
• General health e.g., pruritus
• Mouth disease
• Joint disease
• Autoimmune disease history

Question 6

Why do you need to remember to ask about drug histroy ?

Answer 6

Because drug eruptions are common.

Ask about:

“over the counter” preparations herbal drugs “complementary” therapies other people’s preparations cosmetic preparations

Question 7

Why do you need to rememeber to ask about family history of skin disease ?

Answer 7

To check for the possibility of any inherited skin conditions or autoimmune history

Question 8

Why is occupational history important ?

Answer 8

Because occupation may explain or aggravate condition.

• e.g. florist with facial eczema
• e.g. car mechanic with hand dermatitis

Question 9

What in social history is important in history taking for skin disease?

Answer 9

TRAVELS - e.g., infections, sunshine

HOBBIES - e.g., contact dermatitis

ALCOHOL - e.g., hepatotoxic therapy considered

SMOKING - e.g. palmoplantar pustulosis