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Taking a Dermatological history

How to take a Dermatological History

 

Don't panic about taking a dermatological history from a patient that presents with a skin problem. Dermatological history taking is not completely different from other specialties. Admittedly, there are a few more specific questions and areas to enquire about but apart from that the usual history structure applies. It's imporant to know how to take a dermatological history as up to a third of people at one time have a skin condition. This article contains wwhat should be coevered in a dermatological history and gives a few examples why some of the questions are relvant. Reading about skin conditions will help to understand the history taking process.

 

Introduction

  • Introduce yourself, stress confidentiality and gain consent to take a history from the patient
  • Name, age, occupation (contact dermatitis may be caused by chemicals or products used at work)

 

Presenting Complaint (PC)

Open questions:

  • What seems to be the problem today?
  • Can you describe your skin problem?

 

History of Presenting Complaint (HPC)

  • When did it start?
  • How did it start?
  • Where did it start?
  • Has it changed over time?
  • Where is it now?
  • Is anywhere else? (spread/distribution)
  • What does it feel like?
  • Does anything make it better or worse?
  • Experienced this before?

 

Symptoms

  • Itch
  • Pain
  • Bleeding
  • Discharge
  • Blisters

 

  • Any treatment used? (This can help when formulating a treatment plan. You don't want to give the patient something that they are not keen to try again. Perhaps they have been using herbal remedies too.)
  • Contact history - scabies, chickenpox (contagious conditions)
  • Noticed any problems with your mouth, nails, joints, scalp or hair? (Lichen Planus can cause white streaks in the mouth called Wickham's striae and ulcers arise in Behcet Disease. Psoriasis can cause arthritis and nail changes such as pitting.)
  • How do you feel otherwise? A systematic review could be used here as the presence of pyrexia and malaise are important. Many systemic disease have associated skin conditions - diabetes mellitus and Crohn's disease.

 

Past Medical History (PMH)

  • How is your general health?
  • Previous skin condition?
  • Asthma, hayfever or eczema? (Signs of atopy)

 

Family History (FH)

  • Eczema
  • Hayfever
  • Asthma
  • Psoriasis
  • Skin cancers

 

Drug History (DH)

  • Current medications and length of use (Some medications can cause skin reactions. For example the pill can cause erythema nodosum)
  • Allergies
  • Skin reactions - nickel (some jewellery contains nickel which can cause a contact dermatitis)
  • Use any cosmetics or moisturising creams?

 

Travel History (TH)

  • Where do you come from?
  • Been abroad recently?
  • A lot of sun exposure?
  • Use any suncream - what factor?
  • What does your skin do in the sun? - burn, tan easily

 

Asking questions about the patient's skin type allows you to assess the patients's risk of sun related skin conditions such as actinic keratoses and melanomas. Skin type is classified into 6 categories using the Fitzpatrick Classification Scale.

 

Social History (SH)

  • Alcohol
  • Smoking
  • Home situation - who's there, support available
  • Changes - washing powder, pet (may aggravate skin conditions)
  • Hobbies - gardening (In America plants such as poison ivy can commonly cause a contact dermatitis)
  • Any stressful events - stress can precipitate skin conditions

 

Sexual History

  • Current relationship status - sexually active?
  • Any symptoms down below - pain, discharge, skin changes?
  • Does their partner have any symptoms?
  • Use of condom?

 

    This can be a tricky topic to cover but some sexually transmitted diseases are associated with skin conditions (herpes, syphilis). Try to get a rough idea about the patient's sexual history in order to assess their risk of an infection.

     

    • How is this skin problem affecting your day to day life?

     

      This is a VERY important question. Skin conditions can have a major impact on a patient's life. Ask about the effect it has on hobbies, work, social activities and that patient's choice of clothing (some patients with psoriasis have to avoid dark clothing due to skin flaking).

       

      Ideas, Concerns and Expectations (ICE)

      • What do you think may be causing this skin problem?
      • Any particular concerns/worries?

       

      Summarise

      This is a neat way of clsoing the discussion and if any information is missing or the patient wants to add anything then it is easily done. A complete dermatological history - done!

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