Dermatology Science : The Diagnosis of Skin Disease
The diagnosis of skin disease begins with taking a history. This is followed by careful physical examination. If at this stage a diagnosis has not been made, further examinations should be carried out.
The following information is needed to make a correct diagnosis.
-Past medical history
Conditions which may be associated with skin disease include diabetes, cancer, renal/liver disease and immunodeficiency.
- History of presenting condition
How long has the lesion(s) been present? This is the most important question in the history. Acute lesions presenting for less thann two weeks need to be distinguished from those that are chronic.
Do the lesions come and go?
Do they occur at the same sites or different sites? This is important if a diagnosis of urticaria or herpes simplex is being considered.
Was the lesion caused by trauma/insect bite?
Is there any associated discharge or odour?
Has the patient travelled abroad recently?
- Relationship to physical agents
A past history of living or working in a hot climate may be the clue you need to diagnose skin cancer.
Sun exposure is often indicated by a rash on the face or back of the hands.The important question here is the time interval after sun exposure until the rash appears. In solar urticaria, the rash appears within five minutes of sun exposure and is gone within an hour; in polymorphic light eruption, the rash occurs several hours after sun exposure and lasts several days.
Ask about irritants on the skin if the patient has hand eczema .
Common irritants include detergents, oils and some solutions that are found in the workplace (hairdressers, dental workers).
Are the hands in direct contact with irritants?
What makes the skin condition better?
What makes the skin condition worse?
What treatment has been used to date (medical, herbal and over the counter (OTC))?
-Pruritus (Itching)
Pruritus (itchy skin) is the single most common symptom of many nflammatory skin conditions (see section 06 for Pruritus). Dry skin itself is itchy and requires management with emollient therapies. While itching is distressing to the patient, it may not help you reach a diagnosis.
Excoriation (scratch marks) on the skin provide evidence of pruritus. Severe itch, especially at night, may be caused by scabies . Management of pruritus is an essential component of verall management of the skin condition.
-Past, family and social history
Past history : Has the patient had the rash before and, if so, was it the same as now?
If eczema is present, a history of infantile eczema, asthma or hayfever may suggest a diagnosis of atopic eczema.
Family history : Does anyone else in the family have a skin condition?
Is it the same as the patient’s?
This will indicate that either the skin disease is genetically determined e.g., atopic eczema, psoriasis, ichthyosis) or contagious (e.g. scabies or impetigo).
Social history/hobbies/occupation/recent travel to foreign country :
For instance, does hand dermatitis get better at the weekend, or on holiday?
Hobbies may indicate contact with irritant products or chemicals, etc. Travel to a warm climate may expose the person to tropical infection.
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