2-2

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2-2. PATIENT HISTORY

a. General Information. The patient's history helps the doctor in diagnosing a skin problem. Skin is the barrier between man and his environment. Physical and chemical agents in the environment--poison ivy, insecticides, sunlight, cold, heat, contact allergens, and so forth--act on the skin and cause a variety of skin disorders. To understand what the patient's skin has been exposed to over time, the examiner must obtain the following information:

(1) The patient's occupation.

 

(2) Medications used on the skin problem.

 

(3) The patient's experience with drugs.

 

(4) The season of the year when the skin problem is most evident.

 

(5) The patient's immediate environment including contact with plants, animals, metal, and so forth.

 

(6) Physiologic state of the patient; pregnant, menses.

 

(7) Foods recently eaten.

 

(8) The patient's hobbies.

 

(9) The patient's emotional state.

 

(10) Symptoms at the skin lesions--burning, itching, pain, and so forth.

 

(11) Patient's allergies.

 

(12) Previous treatment for this skin problem if it has occurred before.

b. Importance of Drug Information. Drugs are often the cause of skin eruptions. Skin eruptions caused by drugs usually develop rapidly; therefore, it is generally easy for the patient to remember and give the names of drugs he has taken recently. When asking the patient what drugs he has taken, ask very specific questions such as these:

(1) "Do you take sleeping pills, nerve medicines, vitamins, laxatives, or headache medicines?"

 

(2) "Have you been given any pills for a recent illness?"

 

(3) "Did your doctor give you any shots recently?"

c. Food and Skin Problems. Some foods cause skin problems. Some individuals get hives or wheals after eating strawberries, shellfish such as shrimp, or any kind of nut. Other people develop skin lesions after consuming alcoholic beverages.

d. History of the Skin Eruption. When taking the patient's history, be sure to ask the patient what the skin eruption looked like as it was developing. Obtain this information:

(1) An exact description of the onset of the skin problem.

 

(2) A careful description of the first skin lesion(s).

 

(3) The details of the development and extension of the skin lesion(s).

 

(4) If the skin problem has happened before, ask the patient if he can relate the appearance of skin lesions to any of the factors listed in paragraph 2-2a; common factors such as food, drugs, contact with plants, etc.

e. Patient's General Medical History. Although information about the patient's general medical health is not always obtained, it can be of great help in diagnosing and treating a skin problem. Be sure to ask for this information:

(1) Patient's age. Also record his sex and race.

 

(2) The patient's past medical history: hospital admissions; illnesses; operations; pregnancies; drug sensitivities; hazardous exposure; general health; habits; and diet.

 

(3) Social history: birthplace; residence; and travel (especially foreign).

 

(4) Family history: skin diseases; allergies; diabetes; hypertension; bleeding disorders; anemia; and nervous, muscular, intellectual, or emotional disturbances.

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