Psoriasis history OSCE

Introduction Identification Explanation Consent ICE

Presenting complaint

 rash – appearance, site, onset, duration, evolution

 bleeding, itch, blister, pus
 trigger, exacerbating + relieving factors e.g. moisturiser makes it better?
 number of lesions & their distribution
 associated symptoms e.g. fever, malaise, joint pain
 previous episodes?
 previous or current treatment? effective?
 recent contact history
 sun exposure & Fitzpatrick skin type

PMHx

 general medical + surgical histories

 skin disorders esp. cancer
 atopy – eczema, hay fever, asthma
 DM, IBD – may have skin menifestations
 DM: acanthosis nigricans / scleroderma diabeticorum / necrobiosis lipoidica diabeticorum
 IBD: pyoderma gangrenosum / erythema nodosum

Family hx Examination

 skin disorders esp. skin cancer  first look @ affected area then head
 atopy to toe
 other general conditions  scalp
 around ears
Medication history
 extensor surfaces – knees, elbow
 skin tx e.g. creams, ointments, UV therapy, abx, biologics  back
 regular meds esp. length of treatment  umbilicus
 OTC, herbal + alternative medicines  nails – psoriatic nail dystrophy, pitting,
 cosmetics leukonychia, onycholysis
 allergy e.g. jewellery, nickel etc.  joints

Social history Description of psoriasis plaque

 occupation & exposure esp. irritants  raised

 skin problem worse @ work? better when off work?  well-demarcated
 drink, smoke  erythematous
 illicit drug use  plaques with white scaly covering
 housing & any social care input  size
 recent travel & sun exposure  these lesions are consistent with
 impact on life chronic type plaque psoriasis

Systemic review + summary

 CVS, Resp, GI, GU, CNS & MSK