Taking a history& terminology

Dr Iain HendersonGP Scotstoun

Hospital Practitioner, Western Infirmary

Basic Dermatology Day

Caesarian section

Red Blood Count

Herpes

Diagnosis of skin disease

In medicine in general it is said that 80% of the diagnosis comes from taking a good history,

16% from a good examination and only

4% from investigations.

Dermatology being such a visual specialty, the percentages of the first two may differ but the 96% of diagnoses from these still hold

true.

Presenting complaint

Timing and site•Duration?•Where did it start?•Does it come and go?

Presenting complaint

Nature of lesion/rash•What did it originally look like and has it changed?

•Has it spread locally or elsewhere?

Presenting complaint

Symptoms•Does it itch? •Is it tender to touch?•Was there preceding pain e.g. in herpes zoster (shingles)?

Presenting complaintRelieving/exacerbating factors

•Does anything make it worse e.g. heat, sunlight?

•Does anything make it better?

Age

History takingPast medical history• Has the patient had a skin

problem before?• Is this the same?• Do they have a systemic

disease e.g. diabetes which may have accompanying skin features e.g. necrobiosis lipoidica?

History taking

•Past medical history•Has there been any recent viral or bacterial illness •e.g. guttate psoriasis after a streptococcal throat?

History takingDrug history•Have they tried any topical treatments themselves?

•Have they helped or made it worse?

•Ask about cosmetics in case they contain sensitisers causing dermatitis.

History taking

Drug history

•What prescribed and over the counter oral medications have they taken? Important if one suspects a drug eruption.