Physical Examination

Objective findings should be described in detail, beginning with where on the body the problem started. Objective information is listed in Table 18.3. Diagrams of the distribution of the lesions can be extremely helpful, especially when used in conjunction with photos. Photos may be important to document the lesions for insurance claims and to demonstrate improvement over time (Table 18.3) (16-18).

Worker identifying data Age Gender Skin color Job title Actual job task Insurance information Exposure information Date and time of onset of skin lesion

Previous similar lesion from same job Job task at time of onset Where on the body it started Whether the lesion is painful, burning, or pruritic Previous treatment, over-the-counter or prescription, and did it make the lesion better or worse Presence of other employees at the work site with similar skin lesions

Work description

History of what the employee came in contact with on the job What protective equipment was used? Other jobs the employee might have Use of deodorants, cosmetics, perfumes, or other hygiene products A complete employment and exposure history may be necessary Past history

Prior skin exposures and lesions

Systemic illness

Allergies

Prior compensation claims Social history Recreation Hobbies

Personal habits, e.g., smoking, alcohol use, drug use Jobs around the house or the employee's own ranch or farm

Source: Data from Zugerman (8), Peate (9), Lazarus et al. (16), and Lebwohl et al. (18).

Table 18.3. The physical examination.

Color

Distributions

Externally induced or contact Photodistribution Zosteriform or dermatomal Other terms Generalized Localized Symmetric Flexural or extensor Palmoplantar Factitious Morphology Macule Patch Papule

Nodules and tumors

Plaque

Bulla

Vesicle

Pustule

Ulcer

Erosion

Fissure

Crusting

Oozing

Wheal

Telangiectasia

Induration

Atrophy

Burrows

Scales

Lichenification Comedos Configurations Round lesions

Nummular eczema Targetoid Discoid Annular Serpiginous Herpetiform Linear Reticular Verrucous Guttate Alopecia Factitious Periorificial Periungal Secondary changes Excoriations Hyperpigmentation Hypopigmentation

Source: Data from Lazarus et al. (16), Callen et al. (17), and Lebwohl et al. (18).

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