Dermatology Approach and Management

What should be used when taking the history of a skin lesion?

7 factors and relevant past medical history

What is included in past medical history?

If patient has had anything like this before

Chronic illnesses

Family history

Social history

Setting (for lesion)

What was patient doing when they first noticed the lesion

Chronology (for lesion)

When did the lesion start and how has it changed?

Is it constant or intermittent?

Location (for lesion)

Where is it and has it spread?

Quality (for lesion)

What does it look like?

How big is it? Is it bleeding, draining, etc.?

Quantity (for lesion)

How many lesions?

Aggravating / alleviating factors (for lesion)

Has the patient tried anything for?

What makes it better or worse?

Any recent changes in meds, detergents, foods, skin products?

Associated manifestations (for lesion)

What other symptoms are present?

Itching (pruritus), bleeding, general symptoms

What is required for a proper physical exam?

Appropriate exposure of location

Good lighting

Magnification

Ruler (to determine size)

Gloves

What factors need to be examined to accurately describe the lesion?

Quantity

Type

Shape

Color

Arrangement

Distribution or pattern

Margination

Size

Quantity (descriptor)

How many (solitary, multiple, numerous)

Type (descriptor)

What type of lesion is it?

Primary or secondary lesion

Shape (descriptor)

What is the shape of the lesion?

Round, oval, irregular, umbilicated (resembling the navel)

Color (descriptor)

What is the color of the lesion?

Erythematous, pale, cyanotic

Arrangement (descriptor)

How are lesions arranged?

Referring to groupings of the lesions (linear, annular / round)

Distribution / pattern (descriptor)

How are lesions distributed?

Generalized, isolated, localized, intertriginous, symmetrical

Margination (descriptor)

How defined are the lesions?

Well-defined or ill-defined

Size (descriptor)

How big is the lesion?

Use ruler

Intertriginous

Area where skin folds over skin

Ex. skin under the breasts

How would this lesion be described (shape)?

Annular / round

How would these lesions be described (shape)?

Annular / round

How would this lesion be described (color)?

Dark, brownish black

How would this lesion be described (color)?

Pale / white with erythematous border

How would these lesions be described (margination)?

Well-defined

How would this lesion be described (margination)?

Ill-defined

How would these lesions be described (arrangement)?

Linear

How would these lesions be described (arrangement)?

Grouped

How would these lesions be described (arrangement)?

Disseminated (spread out, not in one area)

How would this lesion be described (distribution)?

Dermatomal

How would this lesion be described (distribution)?

Symmetrical

How would this lesion be described (distribution)?

Intertriginous

Dermatomes

Areas of skin that rely on specific nerve connections on the spine