Search This Blog

Saturday, December 17, 2011

Another Initial Approach


Hx must always consider:
  1. Timeline (acute; sub-acute; chronic)?
  2. Similar in past (new; recurrent)?
  3. Medication/drug history
  4. PHx
  5. Symptoms
    • Direct: itch or pain
    • Indirect: fever; URTI; joint pain; headache; weight loss; fatigue; malaise
  1. For examination of the lesion or rash
    • Number: single lesion; several lesions; or rash?
      • 'First impression':macro characteristics
        • Flat or raised?
          • Furthermore
            • Scaly (=> epidermis)
            • Non-scaly (=> dermis)
            • Pustular
            • Blisters
        • Skin intact or broken?
    • Distribution/region
    • Morphology
      • 'Closer inspection":
        • macular; papular; patch; plaque
        • erosion; ulcer
  2. For the Hx
    • Symptoms, as above
    • Drug Hx: prescribed; over-the-counter; recreational
    • Occupational Hx: work; hobbies/pastimes/activities/sports
    • Contacts: rash; itching; hospitalization
    • PHx:
      • .. medical: other skin disease; diabetes; auto-immune; immunosuppression; rheumatic fever
      • ...  surgical
    • FHx: eczema; psoriasis

NB:
If single lesion
--> ?is lesion or region affected prone to complications?
e.g.
SCC from venous stasis ulcer on lower leg;
Cavernous sinus thrombosis from infected 'danger zone' on the face

If rash
--> ?does it conform to a dermatomal distribution?
e.g.
Herpes zoster ('shingles')
--> ?is it symmetrical?
e.g. Acne rosacea on the face
--> ?is confined to a particular region?
e.g. Venous stasis dermatitis on lower leg
--> ?does it affect a particular cutaneous feature?
e.g. The nails in onychomycosis

No comments:

Post a Comment