Hx must always consider:
- Timeline (acute; sub-acute; chronic)?
- Similar in past (new; recurrent)?
- Medication/drug history
- PHx
- Symptoms:
- Direct: itch or pain
- Indirect: fever; URTI; joint pain; headache; weight loss; fatigue; malaise
- 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
- 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
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