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Patient demographic

Age

Sex

Fitzpatrick skin type

Climate zones (including recent travel)

Geographic environment (including recent travel)

Personal characteristics

Skin type

Intolerances and allergies

Lifestyle

Medical history

Presenting complaint

Broad description of problems

Single lesion

2-10 similar lesions

11-20 similar lesions

Rash

Hair problem

Nail problem

Oral problem

Duration

Cutaneous symptoms

Non-cutaneous symptoms that have accompanied the presenting complaint

Exacerbating factors

Condition characteristics

Distribution

Body location

Arrangement of lesions

Primary lesion type

Secondary lesion(s)

Effect of attempted blanching

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Notes

Hair and scalp — extra information

Extra information

Hair and scalp

Diseases and conditions

Treatments for hair disorders

Patient demographic

Personal characteristics

Presenting complaint

Condition characteristics