Dermatologic skin problems are caused by inflammation, infections, immune response, trauma, or exposure
induced environment.
Morphological Criteria Examination (ASSESS lesions first and document, THEN ASK QUESTIONS) involves the
classification of the lesion based on a number of morphological features (pages 381-386 in the Advanced Health
Assessment and clinical Diagnosis in Primary Care, 6th edition by Dains) Evaluation should be systematic (whole
body, hands and feet):
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Identify the location of the lesion(s).
Identify the distribution of the lesions as localized, regional, or generalized.
Identify whether the lesion is primary (appearing initially) or secondary (resulting from change in a
primary lesion).
Identify the shape of the lesion and any arrangement if numerous lesions are present.
Describe the margins (borders).
Describe the pigmentation, including variations.
Palpate to assess texture and consistency (use gloves),
Measure the size of an individual lesion or estimate size if lesions are numerous or widespread.
QUESTIONS TO ASK MYSELF (in bold) AND A PATIENT (in cursive):
1) Is it a life-threatening rash?
Do you have a fever? Any SOB? Do you have difficulty swallowing? Is the rash tender? Does the rash
involve mucous membranes?
2) Is the rash acute (urticaria, fungal (tinea) infections) or chronic/recurrent (psoriasis, eczema)?
How long have you had this rash? Have you ever had a rash like this before?
3) Where is the rash and its progression?
How did it look initially? Has the spread change? How? Has it spread? Where?
4) What does the presence of pruritis tell me?
Does it itch?
5) What does associated pain tell me?
Is it painful or sore? Does it burn?
6) What do associated symptoms tell me?
Do you have a fever? Sore throat? Headache?
How are you feeling in general?
7) Are there possible contacts or sources of contagion?
Does anyone with whom you live or have close contact have something similar? If so, how long have they
had it for?
Have you traveled recently? Where?
What do you do for a living? What are your hobbies and leisure activities?
Do you have any pets? Have you been around animals?
8) Is there anything that exacerbates or triggers the reaction?
Does anything seem to make it worse?
Do you have any known allergies?
9) Could this rash be caused by a medication?
Are you taking any medications (prescription or OTC?)
Do you have any medication allergies?
Have you had a recent vaccination?
10) Is there a significant dermatologic family history?
Does anyone in your family have chronic skin conditions?