Necessary Elements of a Dermatologic History and Physical Evaluation

Janet M. Cole, Deanna Gray-Miceli


Dermatology Nursing. 2002;14(6) 

In This Article

Quickly Recognizing an Emergency

If the patient presents with a rash, the clinician must immediately ask three questions:

  1. Do you have a fever?

  2. Are you having difficulty breathing or swallowing?

  3. If there is a fever, is the rash tender and is there mucosal involvement?

Fever. In viral rashes, fever is not uncommon and usually the condition is not life threatening. However, fever in the presence of irritability, hypotension, a septic appearance, and a petechial or macular rash may point to meningococcemia, a medical emergency.

Allergic Reaction. Swelling of the airway and/or of the tongue, lips, face, and extremities, as well as coughing, wheezing, and shortness of breath can be caused by angioedema from an allergic reaction. Treatment should be instituted quickly to control the allergic response and prevent possible anaphylaxis.

Fever, Tender Rash With Mucosal Involvement. Stevens-Johnson syndrome or toxic epidermal necrolysis presents with a tender morbilliform rash with fever, conjunctivitis, oral mucosal ulcers, and diarrhea. This is a life-threatening condition requiring immediate hospitalization. The impending exfoliation of large areas of skin requires patient support in a burn unit. If the person's rash is not an emergency, continue with the exam.