Starts with typical patient workup: chief complaint, HPI, PMH, meds, allergies, FH, SH, ROS, PE

HPI: timing, pain, itching, where on the body, how it has evolved, alleviating or aggravating factors, interventions, have they experienced it before, look for atopic triad, ask about any exposures, medications

FH: ask about any family history of the disease or skin cancer

The skin exam:

• Covers the skin, hair, nails, and mucous membranes

• Looking for harmful or dangerous skin lesions, other findings that can help with the chief complaint

• Setup: good lighting (natural, windows), patient undressed in a gown (respect patient's privacy!), measuring tape or ruler, form of magnification, chaperone, sanitize

• Use a systematic approach: examine face, eyes, lips, oral cavity, ears, scalp, neck (including both anterior and posterior inspection), arms, axilla, palms, fingernails, ask patient to stand, examine chest, abdomen, genitalia, back, buttocks ( including perianal area), anterior and posterior legs, feet (dorsum, plantar, toes and toenails), *always ask permission before examining the breasts or genitalia!*

• Use palpation to characterize texture, temperature, consistency

• For non-derm patients, you can still examine the skin by incorporating inspection/palpation into your normal physical exam

• For pediatric patients, try using distraction or having them sit on parent's lap

Taking a picture of an evolving skin lesion for the patient's chart is helpful!

References: AAD Basic Dermatology Curriculum, Dermatology by Bolognia et. al., Lookingbill and Mark's Principles of Dermatology, First Aid USMLE Step 1 2020, First Aid USMLE Step 2 CK