Patient demographic
Age
Age
0-28 days
29 days - 5 years
6-9
10-19
20-29
30-39
40-49
50-59
60-69
70+
Sex
Sex
Male
Female
Fitzpatrick skin type
Fitzpatrick skin type
I
II
III
IV
V
VI
Climate zones (including recent travel)
Climate zones (including recent travel)
Dry climate
Polar climates
Tropical climates
Geographic environment (including recent travel)
Geographic environment (including recent travel)
Coastal
Desert
Grassland/Savana
Mountainous
Rainforest/Jungle
Rural/Farmland
Urban/Metropolitan
Personal characteristics
Skin type
Skin type
Dry skin
Oily skin
Normal skin
Intolerances and allergies
Intolerances and allergies
Coeliac disease
Drug allergy
Contact dermatitis
Lifestyle
Lifestyle
Alcohol consumption
Cigarette smoking
Outdoor exposure
Recreational drug use
Sexually active
Multiple sexual partners
MSM/WSW
Vegetarian/Vegan
Overseas travel
Medical history
Medical history
Previous skin disease
Cardiac
Respiratory
Gastrointestinal
Locomotor
Neurological
Mental
Metabolic
Multisystem
Autoimmune
Immunocompromised
Urogenital
Presenting complaint
Broad description of problems
Duration
Duration
<48 hours
48 hours - 1 week
>1 week < 6 weeks
> 6 weeks
Continuous
Intermittent
Diurnal variation
Cutaneous symptoms
Choose options
Bruising
Cold intolerance
Dysaesthesia
Excessive hair growth - generalised
Excessive hair growth - localised
Hair loss
Heat or warmth
Hyper-wrinkling/furrows
Hyperhidrosis
Localised (lesion-specific) oedema
Nail discoloration
Nail pits (irregular)
Nail pits (regular)
Onycholysis
Pain
Peripheral oedema
Pruritus
Skin fragility
Skin thickening
Skin tightening
Stinging
Stretch marks
Swelling
Telangiectasia
Tenderness
Non-cutaneous symptoms that have accompanied the presenting complaint
Choose options
Abdominal pain
Abnormal vaginal discharge
Anxiety
Blurred vision
Bone pain
Concentration impairment
Chest pain
Chills
Cognitive issues
Conjunctivitis
Cough
Depression
Diarhhoea
Dizziness
Dry eyes and irritation
Dyspareunia
Erectile dysfunction
Fatigue
Fever
Headaches
Hearing loss
Heart palpitations
Heat or cold intolerance
High blood pressure
Hoarseness or other voice changes
Joint pain
Joint swelling
Low blood pressure
Malaise
Muscle weakness
Myalgias
Nausea and vomiting
Nerve pain/tingling
Neurological symptoms
Pain
Penile discharge
Polydipsia
Polyuria
Red eyes
Seizures
Sleep disturbances
SOB
Sore throat
Swollen lymph nodes
Urinary symptoms
Weight gain
Weight loss
Wheezing
Exacerbating factors
Choose options
Light
Heat
Cold
Exercise
Pressure
Possible drug association
Condition characteristics
Distribution
Distribution
Generalised
Localised
Unilateral
Bilateral
Central
Peripheral
Intertriginous
Extensor surfaces
Flexor surfaces
Sparse
Extensive
Sun-exposed areas
Sun-protected areas
Body location
Body location
Abdomen
Perianal
Forearm - dorsal
Forearm - volar
Upper arm
Elbow extensor
Elbow flexure
Axillae
Upper back
Lower back
Breasts
Buttocks
Chest
Ear
Eye
Eyelids - upper
Eyelids - lower
Face - forehead
Face - midface
Face - perioral
Face -cheeks
Face - temples
Face - nose
Face - nasolabial folds
Flank
Foot - dorsum
Foot - sole
Toes
Genitals
Groin
Hair
Hand - dorsum
Hand - palm
Fingers
Hip
Thigh
Calf
Shin
Ankle - medial
Ankle - lateral
Lips
Mouth
Nails - toes
Nails - fingers
Neck
Scalp
Shoulder
Skin folds (flexures)
Arrangement of lesions
Arrangement of lesions
Annular
Arcuate
Geographic
Gyrate
Linear
Grouped or herpetiform
Discrete (no pattern)
Dermatomal
Blaschkoid
Symmetric
Asymmetric
Primary lesion type
Choose options
Macule (impalpable < 1cm)
Patch (impalpable 1cm +)
Papule (raised < 1cm)
Plaque (raised 1cm +)
Indurated plaque
Nodule - solid 1-3cm diameter
Mass - solid >3cm
Cyst
Vesicle
Bullae
Pustule (Pus-filled <1cm diameter)
Abscess (Pus-filled 1cm +)
Wheal/welt/hive
Comedone or follicular plugging
Erosion
Ulcer
Cuts or lacerations
Burn(s)
Secondary lesion(s)
Choose options
Excoriations
Lichenification
Scarring
Effect of attempted blanching
Choose options
Blanching
Non-blanching
