Dermatology history taking Flashcards
What basic demographic details should you collect?
- Age
- Sex
- Race
- Place of residence
What should you ask about the lesions?
- Site and onset - generalised eczema in a patient with preceding venous eczema is likely to be a secondary ‘autosensitisation’ eruption
- Associated symptoms
- Duration - e.g. if enlarging and blackening over months then more suspicius of melanoma
- Fluctuation or persistence - contact allergic dermatitis may imporve on holidays
- Exacerbating/aggrevating or provoking factors - infective/drug triggers may precede eruption by several weeks
- Response/lack of response to previous treatment - opical steroids may help reduce the itch of tinea but they will not improve the extent of the rash, and in some cases they will make it worse (tinea incognito)
What associated symptoms of skin disease might you ask about?
- itching,
- burning,
- soreness,
- pain,
- weeping,
- oozing,
- blisters or odour
What is the FH linked to melanoma?
FAMM syndrome - diagnosed when several family members have large amounts of melanocytic lesions –> more melanoma cases in the family. Identified patients should be screened.
What kind of PMH is relevant in dermatology?
DM and necrobiosis lipoidica
Connective tissue disease e.g. SLE
What kind of drugs can cause skin problems?
Anabolic steroids –> acne vulgaris
Homeopathic medications can sometimes contain steroids and cause LFT abnormalities. Manufacture of some chinese herbal products –> animal cruelty.
What should you address in the social history in dermatology?
- Work and hobbies -> allergic dermatitis
- Exposure to UV
- Alcohol
- Smoking –> palmoplantar pustulosis. Anti-malarial drugs which treat discoid lupus erythematosis are less effective in smokers too.
- Sexual history - STI can cause lesions on genitalia and oral mucosa e.g. HIV
- Travel and infectious disease
List 3 ways in which alcohol is relevant in skin conditions.
- mod-high –> aggrevates chronic inflammatory dermatoses (e.g. psoriasis)
- chronic skin conditions –> depression –> alcoholism
- cannot use methotrexate in those who drink –> increased risk of liver damage
How is psychological history related to skin conditions?
- Stress can aggrevate skin conditions; psychological isseues can cause skin problems such as dermatitis artefactae and delusions of parasitosis.
- How severe does the patient perceive the skin condition to be?
- Psychological problems may arise from skin disease - stops some people going out, working, socialisisng
What kind of examination is usually required in skin disease?
Usually a full examination of the whole skin but sometimes not required e.g. in warts.
Must examine fully those who have large numbers of melanocytic naevi, pre-cancerous lesions, skin cancer
How would you examine a rash?
- General appearance of patient - e.g. thyroid disease, arthritis?
- Distribution, symmetry and colour of rash - e.g. symmetrycal = endogenous cause like psoriasis/atopic eczema; asymmetrical = exogenous cause like tinea; flexural = eczema; extensor = psoriasis.
- Morphology of the rash - colour, shape, symmetry, elevation edge, scale, crust, scratching of each lesion
- Palpate for texture and thickness. Epidermis disorders=visible scale. Remove crust of lesions to see what is underneath. Linear pressure may ellicit response in urticaria.
- Nails, scalp, oral mucosa
- Genitalia - ask about or examine
How can a Woods light aid in diagnosis? (3)
- Yellow fluorescence in pityriasis vesicolor
- Coral pink fluorescence in erythrasma
- The pale areas of vitiligo are exaggerated
What 3 things can diagnosis of a skin condition be based on?
Diagnosis can be based on…
- history
- predominant site affected
- morphology of the lesion
http://www.pcds.org.uk/p/general-dermatology-table
