Dermatological History (Specifically eczema)

Question 1

What PC might you see in derm hx?

Answer 1

Rash

Skin lesion

Pain

Itch

Bleeding

Discharge

Blistering

Systemic symptoms: fever, malaise, weight loss and arthralgia.

Question 2

What acronym can be used to talk about skin lesions?

Answer 2

SOCRATES

Question 3

Give a general list of qs using the SOCRATES acronym for a derm hx

Answer 3

Site
-> “Where is the skin lesion?”

Onset
-> “When did you first notice the skin lesion?”

Character
-> “How does the skin lesion feel when you touch it?”
-> “How many of the skin lesions are there?”
-> “What shape are the skin lesions?”

Radiation
-> “Does the pain spread anywhere else?”

Asso sx
-> “Are there any other symptoms that seem
associated with the rash?”
-> “Have you noticed the skin lesion itching or
bleeding?”

Time course
-> “How has the rash changed over time?”
-> “How has the skin lesion changed over time?”
-> “Have you had a rash like this in the past?”

E /R factors
-> “Does anything seem to make the rash worse?”
-> “Does anything make the rash better?”

Severity
-> “On a scale of 0-10, how severe is the pain, if 0 is no
pain and 10 is the worst pain you’ve ever
experienced?”

Question 4

What do you want to ask in the PMH section of a derm hx?

Answer 4

If y -> control + meds / adherence

Previous surgery or procedures (e.g. excision of skin lesion):

Sun exposure
Assess the patient’s previous sun exposure (including sunbed use) to determine skin cancer risk.

Ask if the patient’s symptoms seem to worsen (e.g. systemic lupus erythematosus) or improve (e.g. psoriasis) after sun exposure.

Previous skin cancer or other dermatological conditions

Atopy

Diabetes (e.g. acanthosis nigricans, scleroderma diabeticorum, necrobiosis lipodica)

Inflammatory bowel disease (e.g. pyoderma gangrenosum, erythema nodosum)

Other medical conditions requiring systemic immunosuppression (increased risk of skin cancer)

Question 5

What do you want to ask in the DHx section of a derm hx?

Answer 5

Allergies -> what kind of reaction they had to the substance (e.g. mild rash vs anaphylaxis).

Prescribed medications or over-the-counter remedies?

SE?

Emollients

Ointments

Topics steroids

Antibiotics

Systemic immunosuppressants (e.g. biologics)

Meds that can make derm sx worse:
-> Skincare products
-> Soaps
-> Cosmetics

Question 6

What do you want to ask in the FHx section of a derm hx?

Answer 6

“Do any of your parents or siblings have any skin problems?”
-> Clarify at what age the disease developed

Question 7

What do you want to ask in the SHx section of a derm hx?

Answer 7

Accommodation
?adaptations to assist them (e.g. stairlift)

Support network

ADLS / indepedent? / carer input

Recently changed any cleaning products which coincide with the development of their symptoms

Smoking

Alcohol

Recreational drug use

IVDU ->increased risk of cellulitis and necrotising fasciitis at injection sites.

Diet -> recently changed their diet or noticed that certain food types seem to trigger their symptoms (e.g. rash associated with coeliac disease).

Occupation

Ask if the patient’s skin problems seem to be worse when they’re working and if the problems improve when they have some time off.

Clarify if the patient is exposed to any skin irritants or other hazardous substances in their work.