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Age

Sex

Fitzpatrick skin type

Climate zones (including recent travel)

Geographic environment (including recent travel)

Skin type

Intolerances and allergies

Lifestyle

Medical history

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

Distribution

Body location

Arrangement of lesions

Primary lesion type

Secondary lesion(s)

Effect of attempted blanching

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Scleroderma