An exposure history should focus on unintentional dermal exposure to any hazardous substances or known allergens found in the home, school or day-care environments.

Questions to Ask

Diagnosis of environmentally related skin disorders must rely on a careful exposure history that might determine a plausible agent of exposure, particularly one to which there was long-term or extensive exposure. This must be accompanied by careful examination of the specific lesion involved and assessment as to its morphological features and anatomic site.

Most of the previously described exposures and effects are commonly associated with acute doses; it is not always clear what their effects are in lower doses, or whether the effects in children are different or occur from different doses. The CH2OP framework is still applicable, but unusual dermatological symptoms are likely explained by a limited number of specific types of exposures.

An exposure history should focus on exploring whether the child has had unintentional dermal exposure to any hazardous substances or known allergens found in the home, school or daycare environments by way of:

• Arts and crafts activities
• Application of insect repellents or treatments for lice
• Parent’s use of unusual topical ointments
• Wearing specific clothing or hair accessories that contact skin

Questions should also be directed to the parents to determine if they have similar dermal effects and/or if chemicals from their work may be accidentally brought into the home as a means of exposure to family members.

Given that the latency for skin cancers is generally 20 years or more, physicians are not likely to have young patients who present with skin cancer lesions. They can, however, play a role monitoring and educating their patients and parents of young patients as to behaviour that increases the risk of skin cancers.

• When outdoors, does the child or infant wear adequate protective clothing, hat, eyewear, or is he or she sheltered from direct sunlight?  Is sunscreen/sunblock used on children?
• Do adolescent patients have an outdoor job in summer?  Do they take adequate precautions to avoid direct sun exposure?
• Does the adolescent patient spend time sunbathing outdoors or at tanning parlours?