31 Questions
What is a common cause of generalized itching without an apparent rash?
Dry skin
What is the primary goal of asking about the effect of topical or oral medications during history taking?
To assess the patient's response to treatment
What is the significance of asking about the impact of the rash on the individual's quality of life?
To understand the patient's psychological distress
Hair shedding at roots is commonly caused by what?
Telogen affluvium
What is suggested by a history of asthma, hay fever, or childhood eczema?
Atopy
What should be inquired about in a patient's family history?
History of atopy and skin conditions
What increases the risk of melanoma by as much as 75%?
Use of indoor tanning beds, especially before age 35 years
What should be assessed if a patient reports a new growth or concerning lesion?
Risk factors for melanoma
What is associated with dermatitis herpetiformis?
Celiac disease
Why is it important to ask about sun exposure?
To assess risk factors for actinic damage or photosensitive eruptions
What is a risk factor for melanoma?
Light eye or skin color
What is a common physical exam finding in individuals with a high risk of melanoma?
Freckles
What is the purpose of performing a hair pull test?
To examine the hair for shedding from the roots
What is the purpose of examining the scalp?
To inspect the scalp for erythema, scaling, and scarring
What is a common method used to separate the hair to see the scalp?
Using a cotton-tipped applicator
What is the purpose of performing a tug test?
To examine the hair for fragility
What is the term for a flat spot that is larger than 1 cm?
Patch
What is the characteristic of a papule?
Raised and smaller than or equal to 1 cm
What is the term for a fluid-filled lesion that is smaller than or equal to 1 cm?
Vesicle
What is the characteristic of a macule?
Flat and smaller than or equal to 1 cm
What is the term for a flat spot that is smaller than or equal to 1 cm?
Macule
What is the characteristic of a plaque?
Raised and larger than 1 cm
What is the term for a fluid-filled lesion that is larger than 1 cm?
Bulla
What is the characteristic of a patch?
Flat and larger than 1 cm
What is the term used to describe a shape that is ring-like with a central clearing?
Annular
What color is often used to describe a lesion that is the same shade as the patient's skin?
Skin-colored
What is the term used to describe a lesion that temporarily lightens in color when pressed with a finger or glass slide?
Blanching
What condition has greasy scaling?
Seborrheic Dermatitis
What is the term used to describe the pattern of a skin lesion, such as linear or dermatomal?
Configuration
What is the term used to describe a lesion that is characterized by a fine, keratotic scale?
Actinic keratoses
What is the term used to describe a lesion that is characterized by a hard, keratotic scale?
Actinic keratoses or SCC
Study Notes
Generalized Itching
- Patients may experience generalized itching without a visible rash due to various underlying conditions, including:
- Dry skin
- Drug reactions
- Pregnancy
- Uremia
- Jaundice
- Thyroid disease
- Polycythemia vera
- Lymphomas and leukemia
History Taking
- When taking a patient's history, ask about:
- Variations in symptoms over time (e.g., pruritus worsening at night)
- Preceding symptoms (e.g., sore throat in psoriasis)
- Aggravating or relieving factors (e.g., exercise, heat, or topical/oral medications)
- Associated constitutional symptoms (e.g., joint pain, muscle weakness, fever, fatigue, or weight loss)
- Impact of the rash on the patient's quality of life
Hair Loss
- When assessing hair loss, ask about:
- Hair thinning or shedding
- Pattern of hair loss (e.g., diffuse, localized, or patchy)
- Hair care practices (e.g., frequency of shampooing, use of dyes, chemical relaxers, or heating appliances)
- Acuity of onset (e.g., sudden or gradual)
- Preceding severe illness or recent pregnancy
Past Medical and Medication History
- Ask about:
- General health and previous medical or skin conditions
- History of asthma, hay fever, or childhood eczema (suggesting atopy)
- Celiac disease (associated with dermatitis herpetiformis)
- Full medication history, including recent oral or topical prescriptions or over-the-counter medications
- Allergies to medicines, food, or environmental factors
Family and Social History
- Inquire about:
- Occupation and hobbies (e.g., exposure to chemicals causing contact dermatitis)
- Foreign travel (considering tropical infections)
- Sun exposure (considering actinic damage or photosensitive eruptions)
- Tanning bed use (increasing risk of melanoma)
- Family history of atopy and skin conditions
Examining the Hair and Scalp
- Examine the hair and scalp by:
- Separating the hair to inspect the scalp from one side to the other
- Noting the distribution, texture, and quantity of hair
- Inspecting the ears
- Performing a hair pull test to examine hair shedding from the roots
- Performing a tug test to examine hair fragility
Describing Skin Findings
- Use descriptive terms to characterize skin lesions, including:
- Shape: circular, oval, annular, nummular, or polygonal
- Color: tan, light brown, dark brown, skin-colored, bright red, purple, or violaceous
- Blanching vs. non-blanching: redness that temporarily lightens or remains unchanged with pressure
- Texture: smooth, fleshy, verrucous, scaly, dry, or greasy
- Location: specific measurements from landmarks or anatomical features
- Configuration: linear, unilateral, dermatomal, grouped, or generalized patterns
Flat Spots
- Characterize flat spots as:
- Macules: small (≤1 cm) and flat
- Patches: large (>1 cm) and flat
Raised Spots
- Characterize raised spots as:
- Papules: small (≤1 cm) and raised
- Nodules or plaques: large (>1 cm) and raised
- Vesicles: small (≤1 cm) and fluid-filled
- Bullae: large (>1 cm) and fluid-filled
Identify the underlying causes of generalized itching in patients, including skin conditions, systemic diseases, and medication reactions. Learn to ask relevant questions during history taking to diagnose the root cause.
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