Dermatological history and examination

Skin diseases are highly prevalent, affecting over half of the population at some point in their life. Although many skin conditions have a good prognosis, some skin cancers and infections are life-threatening and require urgent intervention. Most non-dermatological medical practitioners have little training in skin disease despite its prevalence. A broad understanding of skin disease is an important aspect of higher medical training. This article focuses on how to take a comprehensive dermatological history and examination for skin lesions and rashes. Examination of the hair, nails and mucosae are also highlighted. Physicians should be particularly aware of skin changes that could be associated with systemic disease such as vasculitis or connective tissue disease. A careful history and thorough dermatological examination often allow diagnosis without the need for investigations. The practitioner needs to appreciate how skin tone affects the appearance of skin disease. Use of a hand-held dermoscope allows the user to visualize sub-macroscopic structures and is essential in evaluating suspected skin cancer. Chronic skin diseases such as psoriasis are often associated with profound psychosocial upset and impaired quality of life. The latter should be evaluated in order to provide holistic care