Skin Rash (Exanthema): Medical History

Medical history (history of illness) represents an important component in the diagnosis of exanthema (rash). Family history

• Are there people with the same complaints in your family?

Social anamnesis

Current medical history/systemic medical history (somatic and psychological complaints).

• What symptoms have you noticed?
• Was the onset sudden or gradual?
• On which parts of the body do the manifestations occur?
• Have the appearances changed in shape, color, size, etc.?
• Do you have in the area of skin changes:
  • Pain?
  • Burning?
  • Itching
• How long have these changes been present?
• Do the skin changes occur depending on the season?
• Are there other symptoms such as fatigue, fever, sweating, fatigue, pain, lymph node enlargement, etc.?

Vegetative anamnesis incl. nutritional anamnesis.

Self anamnesis incl. medication anamnesis

• Pre-existing conditions (infectious diseases, skin diseases).
• Self-treatment?
• Operations
• Allergies
• Pet contact?

Medication history

• ACE inhibitor4
• Allopurinol
• Analgesics
  • Non-acidic analgesics (metamizole, paracetamol).
  • Nonsteroidal anti-inflammatory drugs (NSAIDs) – ibuprofen, diclofenac, naproxen, salicylates (acetylsalicylic acid, ASA).
  • Opioid receptor antagonist (naltrexone).
  • Opiates (codeine)
  • Phenazone derivatives6
  • Pyrazolones6
• Antibiotics
  • Aminoglycosides1
  • Betalactam antibiotics1 (β-lactam antibiotics) (approximately 50% of all drug intolerances; approximately 0.7-8% of all patients with β-lactam antibiotics have allergic reactions)
    • Aminopenicillins (amoxicillin); esp. as amoxicillin/clavulanic acid combination (frequency: very low)
    • Cephalosporins
  • Quinolones/fluoroquinolones/gyrase inhibitors (ciprofloxacin, moxifloxacin).
  • Chloramphenicol3
  • Epoxide antibiotics (fosfomycin trometamol).
  • Fusafungin
  • Polypeptide antibiotic (bacitracin3)
  • Macrolide antibiotics/macrolides (erythromycin)
  • Neomycin3
  • Nitrofurans (nitrofurantoin)
  • Penicillins3
  • Sulfonamides1, 3, 6 (sulfamethoxazole)
  • Staphylococcal penicillins (flucloxacillin).
  • Tetracyclines4, 6
  • Trimethoprim
• Antiepileptic drugs
  • Carboxamide derivatives (eslicarbazepine acetate).
  • Classical antiepileptic drugs (carbamazepine).
• Antihistamines3 (cimetidine).
• Antihypertensives
  • ACE inhibitors (enalapril)
  • Beta-blocker4
  • Methyldopa
• Antifungals
  • Allylamines (terbinafine)
  • Griseofulvin
• Antiprotozoal
  • Analogue of the azo dye trypan blue (suramin).
  • Pentamidine
• Anthelmintics (diethylcarbamazine, mebendazole, niclosamide).
• Antitussives
  • Opioids (codeine, dihydrocodeine, hydrocodone).
  • Non-opioid antitussives (levodropropizine, noscapine, pentoxyverine).
• Antihistamines (cimetidine).
• Antipsychotics (neuroleptics) – chlorpromazine, phenothiazine.
• Arsenic trioxide
• Biologicals
  • TNFα blockers (anti-TNF-α antibodies) – adalimumab, golimumab, infliximab.
• Chelating agents
  • D-penicillamine
  • Trieethylenetetramine dihydrochloride (Trien)
• Quinidine4
• Chloroquine4
• Cinnarizine5
• Diuretics (furosemide, hydrochlorothiazole, thiazides4)
• Folic acid antagonist (methotrexate).
• Gold4 (gold salts)
• Heparin2
• Hormones
  • Insulins2
  • Estrogens (ethinyl estradiol, estradiol)
  • Thyroid drugs, unspecified.
• Hydantoins1
• Immunosuppressants (leflunomide)
• Insecticides and acaricides (contact insecticides).
  • Pyrethroids (allethrin, permethrin).
  • Pyrethrins (pyrethrum)
• Intestinal anti-inflammatory (sulfasalcin).
• Lithium4
• Local anesthetics (benzocaine3, lidocaine3)
• Monoclonal antibodies
  • Anti-CD20 antibodies (rituximab).
  • Anti-CD25 antibody daclizumab (DAC).
  • IgG2 anti-RANKL antibody (denosumab).
  • PD-1 immune checkpoint inhibitors (nivolumab).
• Perchlorates (perchlorate)
• Parasympatholytics (also called anticholinergics) – atropine.
• Parasympathomimetics
  • Anetholtrithione
  • Pilocarpine
• Penicillamine5
• Phytotherapeutics (St. John’s wort)
• Sedatives
  • Barbiturates1
  • Benzodiazepines
• Thrombopoietin receptor agonist (eltrombopag).
• Tuberculostatics (isoniazid
• Uricostats (febuxostat)
• Vasodilators (hydralazine1)
• Antivirals
  • Fusion inhibitors (enfuvirtide)
  • Integrase inhibitors (elvitegravir).
  • Nucleoside analogues (aciclovir, cidofovir, famciclovir, foscarnet, ganciclovir, valaciclovir).
  • Protease inhibitors (simeprevir).
• Cytokines2 (interferon ß-1a, interferon ß-1b, glatiramer acetate).
• Cytostatics
  • Alkylants (Adriamycin, Doxorubicin).
  • Platinum derivatives (carboplatin)
  • Taxanes (paclitaxel)

1 Type I allergy (immediate type)2 Type III allergy (Arthus phenomenon)3 Type IV allergy (allergic late-type reaction)/allergic contact dermatitis4 Type IV allergy (allergic late-type reaction)/Lichen ruber-like or psoriasiform AME5 Type IV allergy (allergic late-type reaction)/blistering AME6 Fixed drug exanthema.

The list of drugs represents only the most common triggers. There is no claim to completeness. Environmental history

• Cosmetics
• Sun
• Vapors
• Dusts