History Reference

Historical questions used in the cases are standardised from the following table.

1. Please tell me how the problem began. Asking the patient to outline the development of the condition may assist you in determining causation. It will also be useful in assessing disease process and flagging malignant or premalignant lesions.
2. Can you think of anything that might have caused it? Precipitating environmental factors, injuries, allergens, etc.
3. Do you burn easily, or have you been sunburned often? Many dermatological conditions can be precipitated or exacerbated by sun exposure. Melanomas, lentigines, and certain premalignant lesions are often directly related to sun exposure. Easy burning may also denote skin which is particularly susceptible to some of these conditions.
4. Does it hurt? Pain or paraesthesia in a lesion can narrow the list of possible diagnoses -- some conditions are particularly painful, or produce some other sensation in the skin, while others can be accompanied by a characteristic numbness.
5. Does it itch? Certain fungal infections and auto-immune conditions are characteristically itchy. The presence or absence of itching can help you focus your assessment.
6. Are you taking any medications, or do you have any known drug allergies or sensitivities? Drug allergies or sensitivities can produce a wide range of skin reactions. This question can also help you assess options for therapy.
7. Do you have any chronic medical conditions (i.e. diabetes, hypertension)? Persistent medical conditions may make a patient more susceptible to certain types of skin diseases, or may be directly causative of lesions.
8. Do you have any diseases that run in your family? Skin symptoms can mark the onset of some hereditary diseases. Additionally, susceptibility to certain forms of cancer can be hereditary.
9. Do you smoke, drink, take drugs, or have unprotected sex? All of these behaviors put a patient at risk for a range of illnesses, some of which may manifest with dermatological symptoms. Smokers are more likely to develop cancers of the mouth, and may also have a lower resistance to some types of infection. Excessive alcohol consumption can cause liver damage, leading to jaundice and other skin symptoms. Intravenous drug users or people who practice unsafe sex are at a higher risk for HIV infection, which lowers the body's resistance to infection and may also precipitate certain rare forms of cancer, such as Kaposi's sarcoma.
You may ask as many of these questions as you like, distilling salient details into your subjective description in the chart. During case review, aspects of the history which are relevant to the illness will be discussed.