Dermatology or Rash History Taking | OSCE Tips
Dermatology or rash, history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a dermatology history during an OSCE.
Presenting complaint (PC):
What brought you here today?
Can you describe your skin problem?
History presenting complaint (HPC):
You can adapt SOCRATES to explore skin problems too: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors and Severity.
Site: where is the skin problem located? is in one location or several places on the skin?
Onset: when did it start? suddenly or gradually?
Character: how would you describe the rash/lesion? (ulcer, scaling, blister, colour change)
Radiation: does the pain spread anywhere else? have you noticed any pattern?
Associate symptoms:
joint pain
Fever
Discharge
Timing: are the symptoms getting worse or better?
Exacerbating/Relieving factors: does anything make it better or worse? (exposure to chemical, sunlight, allergens)
Severity: from a scale from 1 to 10. with 10 being the worse, how would you rate your pain?
Ideas, Concerns & Expectations (ICE):
Now is a good idea to ask Ideas, Concerns & Expectations (ICE): do you have an idea what might be causing your symptoms? is there anything that particularly concern you? what were expecting to achieve in this consultation?
Past medical history (PMH):
Ask about any previous episodes of dermatological issues or treatment or investigations for skin conditions?
Drug history (DH):
Are you taking any medication (prescribed or over-the-counter (OTC)? If so, any side effects.
Any recent use of medications that might have caused a reaction?.
Allergies:
Are you allergic to any medications?
Family history (FMH):
Is there any family members who have similar symptoms?
Social History (SH):
Ask about living condition, occupation and social support.
Do you smoker? alcohol? recreational drug use?
Any recent travel and sun exposure?
System review:
Review each body system to check for any other symptoms that might be causing the rash/lesion.
Possible differential diagnosis:
Inflammation or eczema
Infections:
bacteria (e.g impetigo, folliculitis, cellulitis)
fungal
viral (e.g. molluscum contagiosum, herpes, warts)
parasite (e.g. lice, scabies)
Hypersensitivity reaction:
Urticaria, angiodema
Drug reaction ( e.g. Stevens-Johnson syndrome
Skin cancer.
Others: Acne, Rosacea, Vitiligo, Scelroderma etc.
Summaries your findings.
Investigation:
Skin scraping for culture
Skin biopsy
Bloods: full blood count (FBC), C-reactive protein (CRP) + Erythrocyte Sedimentation Rate (ESR), Autoimmune bloods ( e.g. Rheumatoid factor (RF), antinuclear antibodies (ANA).
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