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HISTORY TAKING IN DERMATOLOGY

ID: Age, race, sex, occupation, hobbies

HPI:

  1. When did the rash/lesion start or was first noticed?

  2. Where did it start?

  3. Symptoms: E.g., does it itch, hurt, burn?

  4. Evolution: How has it spread or developed over time?

  5. What makes the rash or symptoms worse? E.g., heat, cold, sun, exercise, season

  6. What therapy has been tried?—dose, duration, frequency of actual use

Contacts (where appropriate): Pets or farm animal contact, travel, motel stays

PMHx: Diabetes, hypertension, atopy (eczema, asthma, hay fever), previous skin cancers or other skin problems; STDs, HIV, blood transfusions

Medications: Dosage listed for any derm drugs; specific topical steroid names

Allergies (& specific reaction)

Habits: Smoking, alcohol, drug abuse

FamHx: Psoriasis, melanoma, atopy, genetic conditions (e.g., neurofibromatosis)

Constitutional symptoms (if relevant: infection, previous malignancy): Headache, fever, chills, sweats, fatigue, weakness, anorexia, weight loss

Review of systems: Based on clinical scenario. E.g., If autoimmune connective tissue disease is in the differential, ask about arthralgias, myalgias, aphthous ulcers, keratoconjunctivitis sicca, Raynaud’s phenomenon, neurologic or renal problems.

APPROACH TO DESCRIBING SKIN LESIONS

Mnemonic: LES T. CABS

Descriptors

Location & Distribution

Symmetrical, asymmetrical, sun-exposed, flexures/extensors, acral (hands/feet)

Erythema

Erythematous or nonerythematous lesions &/or underlying skin

Surface Features

Crusting, rough, smooth, scaly, warty

Type

Cyst, macule, papule, pustule, ulcer, vesicle

Color

Blue, brown, pink, purple, red, white

Arrangement

Single or multiple, discrete, unilateral, generalized, disseminated, grouped, annular, gyrate, dermatomal, linear, serpiginous

Border & Shape

Well- or poorly defined, active edge, round, oval, irregular, pedunculated

Special Sites/Systemic

Scalp, mouth, nails, genitalia, systemic disease, constitutional symptoms

Terminology of Dermatology

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Lesion

Definition

Examples

Abscess

Accumulation of pus in the dermis or subcutaneous tissue

Perianal abscess, Staphylococcus aureus infection

Annular

Ring-shaped

Granuloma annulare, tinea corporis

Atrophy

Depressed surface due to a thinned epidermis and/or dermis and/or subcutis

Lichen sclerosus, necrobiosis lipoidica, prolonged potent topical steroid use

Bulla (blister)

A large, circumscribed, fluid-containing elevation (>5 mm)

Bullous impetigo, bullous pemphigoid, pemphigus vulgaris

Burrow

Liner S-shaped elevated channel in the epidermis

Scabies

Carbuncle

Inflammatory nodules or abscess of numerous contiguous hair follicles

Hidradenitis suppurativa

Comedo

Plugged pilosebaceous follicle containing serum & keratin. Closed = whitehead; open = blackhead

Acne

Crust (scab)

Dried serum, pus, or blood (usually preceded by vesicle, bulla, or pustule)

Herpes simplex or VZV, impetigo

Cyst

Nodule containing fluid, cells or keratin

Epidermoid cyst, mucous cyst, pilar cyst

Ecchymosis (“bruise”)

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