History Taking in Dermatology

Value of Diagnosis

• Guides management and prognostication

• Minimises contagion & clinical uncertainty; promotes patient ownership

• Aids detection of associated conditions

• Provides clinician satisfaction and supports exam success

Core Dermatology Skills

• Take focused skin history

• Perform complete skin examination

• Accurately describe lesions (site, size, shape, colour, surface, borders, distribution)

• Utilise key diagnostic tests: Potassium hydroxide (KOH) prep, shave biopsy

Structured Skin History

• Chief complaint: enlarging bump, changing spot, acne, eczema, itch, new rash, etc.

• History of Present Illness

  • Onset & duration

  • Initial location and subsequent spread

  • Course: continuous or episodic

  • Modifying, provoking & relieving factors

  • Associated symptoms: itch, pain, bleeding, weeping

  • Prior or current treatments (topical, systemic, OTC)

• Past Medical History

  • Previous dermatologic diseases

  • Immunosuppression, asthma, allergic disorders

• Family History

  • Skin diseases, skin cancers, atopy (asthma/allergies)

• Social/Occupational History

  • Exposures, contacts with similar symptoms

• Drug History

  • Current and previous medications (prescribed & non-prescribed)

• Review of Systems

  • Joint pain, respiratory symptoms, systemic signs

Lesion-focused Questions (Patient’s Own Words)

• Describe the lesion/rash

• Changes over time in appearance, size, or number

Associated Structures

• Scalp & hair changes (alopecia, scaling)

• Mucous membranes (oral, genital)

• Nails (pitting, onycholysis, discoloration)

Complete Skin Examination Checklist

• General impression: well vs ill appearing

• Scalp, face, ears, eyes, nose, mouth, neck

• Chest, abdomen, back, buttocks, genitalia

• Upper & lower extremities (bilaterally)

• Hands, feet, digits, nails

Dermatology Diagnostic Workflow

History → Examination → Clear descriptive language → Targeted investigations