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Taking a dermat ological hist ory is an important skill that is often assessed in the OSCE setting.
It usually involves taking a history of a skin lesion or rash, and it’s important to have a systematic
approach to ensure you don’t miss any key information. The guide below provides a framework to
take a thorough history of any skin problem.
Check out the dermatology history taking OSCE mark scheme here.
Gain consent
Presenting complaint
It ’s import ant t o use open quest ioning t o elicit t he pat ient ’s present ing complaint
Allow t he pat ient t ime t o answer, t rying not t o int errupt or direct t he conversat ion
“Ok, so tell me more about the rash” “Can you explain what that pain was like?”
Int ermit t ent or cont inuous – is the skin problem always present or does it come and go?
Precipit at ing fact ors – are there any obvious triggers for the symptom?
Relieving fact ors – does anything appear to improve the symptoms (e.g. steroid cream)?
Associat ed feat ures – are there other symptoms that appear associated (e.g. fever/malaise)?
Previous episodes – has the patient experienced this problem previously?
When?
How long for?
Was it the same or different than the current episode?
Previous or current t reat ment for t his skin problem (did it work?):
Prescribed medication
Over the counter medication
Cont act hist ory – has the patient been in contact with an infectious skin problem (e.g.
chickenpox)?
If any of these symptoms are present, gather further details as shown above (Onset / Duration /
Course / Severity / Precipitating factors / Relieving factors / Associated features / Previous episodes)
Pain
If pain is a sympt om, clarify t he det ails of t he pain using SOCRATES
Concerns – explore any worries the patient may have regarding their symptoms
Expect at ions – gain an understanding of what the patient is hoping to achieve from the consultation
Summarising
Summarise what the patient has told you about their present ing complaint .
This allows you to check your underst anding regarding everything the patient has told you.
Once you have summarised, ask the patient if there’s anything else that you’ve overlooked.
Continue to periodically summarise as you move through the rest of the history.
Signposting
Signpost ing involves explaining t o t he pat ient :
What you have covered – “Ok, so we’ve talked about your symptoms and your concerns
regarding them”
What you plan to cover next – “Now I’d like to discuss your past medical history and your
medications”
Skin cancer
Atopy – eczema / hay fever / asthma
Other dermatological conditions
Ot her medical condit ions – many of which can have dermatological manifestations
Drug history
Skin t reat ment s – creams / ointments / UV therapy / antibiotics / biologics
Regular medicat ion – including length of treatment (paying particular attention to those started
around the time of the skin problem)
Cosmet ics
Herbal remedies
Family history
Skin condit ions – e.g. psoriasis / hereditary hemorrhagic telangiectasia
Skin cancer
Social history
Occupat ion:
Smoking – How many cigarettes a day? How many years have they smoked for?
Travel history
Where did t he pat ient t ravel t o?
Sun exposure – was the skin problem worsened by sun exposure? (e.g. facial rash in lupus)
Systemic enquiry
Systemic enquiry involves performing a brief screen for symptoms in other body systems.
This may pick up on symptoms the patient failed to mention in the presenting complaint.
Some of these symptoms may be relevant to the diagnosis (e.g. arthralgia in psoriatic arthritis).
Choosing which symptoms to ask about depends on the presenting complaint and your level of
experience.
GI – Appetite / Nausea / Vomiting / Indigestion / Dysphagia / Weight loss / Abdominal pain / Bowel
habit
Urinary – Volume of urine passed / Frequency / Dysuria / Urgency / Incontinence