Taking a history & terminology Dr Iain Henderson GP 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? Duration? Where did it start? Where did it start? Does it come and go? Does it come and go?

Presenting complaint Nature of lesion/rash What did it originally look like and has it changed? What did it originally look like and has it changed? Has it spread locally or elsewhere? Has it spread locally or elsewhere?

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

Presenting complaint Relieving/exacerbating factors Does anything make it worse e.g. heat, sunlight? Does anything make it worse e.g. heat, sunlight? Does anything make it better? Does anything make it better?Age

History taking Past medical history Has the patient had a skin problem before? Has the patient had a skin problem before? Is this the same? Is this the same? Do they have a systemic disease e.g. diabetes which may have accompanying skin features e.g. necrobiosis lipoidica? Do they have a systemic disease e.g. diabetes which may have accompanying skin features e.g. necrobiosis lipoidica?

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

History taking Drug history Have they tried any topical treatments themselves? Have they tried any topical treatments themselves? Have they helped or made it worse? Have they helped or made it worse? Ask about cosmetics in case they contain sensitisers causing dermatitis. 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. What prescribed and over the counter oral medications have they taken? Important if one suspects a drug eruption.