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Focused history: persistent itchy rash
Scenario setup
- Conversation partner
- Jessica, patient
- Learner level
- Preclinical
- Your role
- Medical learner taking a focused history under the supervising clinician
- Your scope
- Elicit a skin history and recognize concerning changes. Do not grade an unseen rash, diagnose exclusively from history or prescribe a new regimen.
- Setting
- Outpatient skin-history visit; spoken descriptions only.
- Situation
- Jessica, 28, seeks help for a chronic intensely itchy rash with a current winter flare.
- Your task
- Characterize distribution and appearance, timeline/itch/triggers, atopic and treatment history, and signs needing prompt assessment.
- Time limit
- 2 min
- Who begins
- You speak first. Your conversation partner waits for you.
Available information
- Initial clinical context
- Jessica, 28, seeks help for a chronic intensely itchy rash with a current winter flare.
- Supervision and information limits
- The supervising clinician is available to review today. No examination, vital signs, test results or medication doses are supplied beyond those explicitly stated. The learner proposes assessment; the encounter does not establish that tests, referrals or treatment have occurred.
- Information supplied in the referral/briefing
- Source briefing describes several years of itchy arm rash that is worse this winter.
What you’re assessed on
- Rash Morphology Description
- Ask patient-reported color, texture, scale/thickening, borders, symmetry, location and oozing; distinguish descriptions from visual findings.
- Symptom and Exposure History
- Clarify chronicity, flares, itch/pain, sleep impact, weather/bathing/products and household/work exposures.
- Red Flag Screening
- Ask fever, severe pain, rapidly spreading redness, pus, blisters and face/eye involvement; explain prompt evaluation for concerning changes. A pigmented-lesion checklist applies only if such a lesion is reported.
- Patient Context and History
- Review asthma/allergies, family history, skin care and treatment names, duration, frequency, benefit/irritation, other medicines and goals; explain uncertainty and supervised review.