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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