General Dermatology - History

Unwell with systemic upset

With a generalised rash

i) Infection

• Common
  • Viral exanthems
  • Varicella zoster
• Uncommon
  • Eczema herpeticum
  • Measles
  • Meningococcal septicaemia
  • Other septicaemia
• Rare
  • Staphylococcal scalded skin syndrome

ii) Other causes

• Erythema mulitforme
• Stevens-Johnson syndrome / toxic epidermal necrolysis
• Acute febrile neutrophilic dermatosis (syn. Sweet's syndrome)
• Generalised pustular psoriasis
• Erythroderma

With a localised rash

• Common
  • Cellulitis
  • Facial cellulits (syn.erysipelas)
• Uncommon
  • Vasculitis
  • Acne - pyoderma faciale, acne fulminans
• Rare
  • Necrotising fasciitis
  • Ecthyma gangrenosum - arising in immunocompromised patients
  • Anthrax

Itch

Common & generalised

• Eczema
• Lichen simplex chronicus
• Urticaria & angioedema
• Scabies
• Chickenpox (syn. varicella zoster)
• Generalised pruritus (with no rash)

Common & localised

• Eczema
• Lichen simplex chronicus
• Tinea
• Pediculosis

Uncommon

• Lichen planus
• Dermatitis herpetiformis
• Grover’s disease
• Nodular prurigo
• Bullous pemphigoid (and pre-bullous eruptions)
• Sea bather’s eruption (bathing suit distribution)
• Notalgia paraesthetica (scapula region)
• Brachio-radial pruritus (brachio-radial region)
• Grover's disease

Pain / tenderness

Common

• Furuncle / Carbuncle
• Cellulitis
• Facial cellultis (syn. erysipelas)
• Herpes simplex
• Herpes zoster

Uncommon / rare

• Erythema nodosum
• Pyoderma gangrenosum
• Kerion (inflammatory tinea of the scalp)
• Vasculitis
• Zoonoses (e.g. orf, milkers nodule, erysipiloid and anthrax)
• Erythromelalgia (feet)

Beware

• Necrotising fasciitis – hot and tender, level of pain out of proportion to initial clinical findings. Eventually deep necrosis occurs
• Ecthyma gangrenosum - localised necrotic area in immunocompromised patient

Light induced (Photodermatoses)

Often spares infra-orbital ridges, philtum, upper lip & sub-mental areas

• Polymorphic light eruption
• Drug-induced
• Chronic actinic dermatitis
• Solar urticaria
• Porphyria
• Actinic prurigo
• Hydroa vacciniforme
• Lupus erythematosus

Reactive erythema

Periodic, erythematous rashes lasting for several weeks. Cause often unknown

• Toxic urticated erythema
• Annular erythema’s e.g. erythema annulare centrifugum
• Jessner-Kanof syndrome

Temperature

Symptoms dependant on temperature

Cold

• Perniosis (chilblains)
• Raynaud’s phenomenom
• Cold urticaria
• Acrocyanosis (persistent mottled discolourisation)
• Cryoglobulinaemia (livedo, purpuric lesions, ulcers)
• Leiomyomata

Heat

• Erythromelalgia

Drug history

Drugs may be relevant in two main ways:

• Topical treatment e.g. contact allergic dermatitis
• Drug eruptions are associated with 2% of systemic treatments

Social history

• General lifestyle - stress can exacerbate many skin problems

• Alcohol - moderate to high alcohol consumption worsens many inflammatory dematoses

• Cigarrette smoking - is associated with palmoplantar pustular psoriasis. Anti-malarial drugs used for treating a number of skin conditions are less effective in patient who smoke

• Work
  
  • Contact allergic dermatitis
  • Zoonoses
  
  
• Travel - infections acquired abroad
  • Leishmaniasis
  • Cutaneous larva migrans
  • Myiasis
  • Leprosy
  • Syphilis

Systemic disease with cutaneous manifestations

Connective tissue disease

• Lupus erythematosus
• Systemic sclerosis
• Dermatomyositis

Diabetes

• Necrobiosis lipoidica
• Diffuse granuloma annulare

Inflammatory bowel disease

• Pyoderma gangenosum
• Acute febrile neutrophilic dermatosis (syn. Sweet’s disease)
• Erythema nodosum

Paraneoplastic phenomena

• Acanthosis nigricans
• Acanthosis palmaris
• Acquired icthyosis
• Panniculitis
• Acute febrile neutrophilic dermatosis (syn. Sweet’s disease)
• Dermatomysositis
• Pemphigus
• Erythroderma

Others

• Thyroid (alopecia, pre-tibial myxoedema)
• Chronic liver and kidney disease (pruritus)
• Haematological disorders (e.g. pruritus, B-cell lymphoma, leukaemia cutis)
• Sex-hormone abnormalities (e.g. hirsutism & other virilisation)
• Addison’s disease (hyperpigmentation)
• Acromegaly (thickening of skin)

Pregnancy

• Polymorphous eruption of pregnancy
• Prurigo of pregnancy
• Cholestasis of pregnancy
• Pemphigoid gestationis

Psycological conditions - habit, stress and psycoses

Stress / Habit

• Neurotic excoriations (patients admit to picking)
• Acne excoriée
• Lip-licking cheilitis
• Lichen simplex chronicus
• Nodular prurigo

Primarily factitious

• Dermatitis artefacta (patient denies they are causing the problem)

Other

• Delusion of parasitosis
• Dysmorphophbia (distorted body image)

Abuse

• Adults - domestic violence / sexual abuse
• Child abuse – neglect / non-accidental injury / sexual abuse (genital and anal warts, premenstrual bleeding, STI) / fabricated or induced illness (previously referred to as Munchausen by proxy)

Genodermatoses

There are many more genodermatoses than those listed below. To find out more about this group of conditions please refer to the 'Resouces - disease specific' section of this website

• Albinism
• Ectodermal dysplasia
• Ehlers-Danlos syndrome
• Epidermolysis bullosa
• Icthyosis
• Incontinentia pigmenti
• Neurofibromatosis
• Peutz-Jeghers Syndrome
• Tuberous sclerosis
• Xeroderma pigmentosum