Dermatological History

Profile: Age, sex, occupation

PC: rash, lesion, etc
HPC:
● when did the rash/lesion first start or was first noticed?
● where did it start?
● Symptoms: How does it feel/act?
○ itch, burn
○ pain
○ bleeding
○ exudates
● Evolution: How has it spread or developed over time?
○ size
○ shape
○ colour
● What makes the rash or symptoms worse? Eg heat, cold, sun, exercise, season
● What type of therapy has been tried? - dose, duration, frequency of actual use
● Other symptoms:
○ hairloss
○ joint pain
○ lethargy
○ headache
○ fever, sweats, chills
○ weakness
○ anorexia
○ weight loss
Contacts
● pets or farm animal contact
● bites
● travel, accommodation changes
● changes in diet
● changes in washing detergents, shampoos, other body products
PMHx
● diabetes
● hypertension
● atopy (asthma, eczema, allergic rhinitis)
● previous skin cancers or other skin problems
● STDs
● HIV
● blood trnasfusions
Medications:
● changes to medications
● list of medications and dosages
● list of derm drugs, and specific steroids (if used)
Allergies
● allergies? and specific reactions?
SHx
● smoking, alcohol, drug use
● hobbies
FHx
● psoriasis
● melanoma
● atopy
● genetic conditions (eg neurofibromatosis)
Review of Systems
● based on clinical scenario
e.g. if autoimmune connective tissue disease is in the differential, ask about arthralgias,
myalgias, aphthous ulcers, Raynaud’s phenomenon, neuro or renal problems

Physical Examination
General Inspection
● scan head to toe for any lesions, rashes, skin/hair/nail abnormalities
● remember to inspect inner thighs, undersurface of breast, external genitalia, axillae,
natal cleft (between buttocks), mucosal surfaces of mouth
● skin colour

Inspecting a Lesion
● grouped or solitary
● distribution and location:
○ symmetrical/asymmetrical?
○ peripheral?
○ in only light exposed areas?
○ dermatomal?
● Colour
● shape
● size
● surface
● edge
● nature of surrounding skin

Palpation
● tenderness
● consistency
● temperature
● depth/height
● blanching
● sensory changes
● mobility
○ what layer of skin is it in, and is
it attached to any underlying structures?
○ can it be moved in all directions?