Skin Assessment and Anatomy Overview

Skin Assessment

• Importance of Inspection: Thorough skin assessment is crucial, especially in newly admitted or immobile patients, to identify skin breakdown or other issues.
• Comprehensive Evaluation: Assessment should include hair, nails, and subcutaneous tissue, not just the skin itself.
• Present on Admission (POA) Skin Breakdown: This should be noted for any patients needing in-depth evaluation, particularly patients newly admitted or with limited mobility. This includes the entire skin surface, from head to toe.

Skin Layers

• Epidermis: The outermost, thin layer of skin with no blood vessels. It is replaced every 3-4 weeks.
• Dermis: Provides nutrition to the epidermis and is rich in blood vessels.
• Subcutaneous Tissue: Stores fat as energy.

Glands and Functions

• Sebaceous Glands: Secrete sebum onto the skin surface (except palms and soles) to lubricate hair and skin, reducing water loss.
• Sweat Glands (Eccrine): Regulate body temperature.
• Sweat Glands (Apocrine): Located primarily in the axilla and genital regions, stimulated by stress; largely responsible for body odor (sweat plus bacteria).

Nails: Assessment and Significance

• Capillary Refill: Prolonged refill time may indicate cardiovascular or respiratory issues.
• Shape and Contour: Note any abnormal shapes (clubbing, spooning, jagged). Clubbing, for example, can indicate congenital factors or chronic CO2 retention. Spooning (concave curves) might suggest iron deficiency. Jagged nails may be due to chronic anxiety.
• Grooves: Assess transverse and longitudinal grooves. Transverse grooves suggest nutrient deficiency; longitudinal grooves are often normal.
• Paronychia: Swollen, tender nail folds suggest fungal or bacterial infections.

Health History and Risk Factors

• Skin Disease History: Note any past or present skin conditions.
• Systemic Disease Impact: Many systemic diseases have skin manifestations.
• Potential for Abuse: Evaluate for potential physical abuse.
• Pressure Injury Risk: Identify patients at risk for pressure injuries.
• Skin Cancer Susceptibility: Assess risk factors for skin cancer.
• Health Promotion Education: Educate patients about skin health.
• Contagious Diseases: Certain contagious diseases (e.g., measles, rubella, chickenpox) can start with skin rashes.

Genetic and Cultural Variations

• Eccrine Gland Activity: Eccrine gland function varies based on environmental and individual adaptations. People in tropical regions generally have more active glands, leading to lower chloride excretion in sweat.
• Apocrine Gland Differences: Racial differences exist in apocrine gland function.
• Skin Cancer Risk: Lighter skin tones (especially with light eyes and freckles) have a higher risk of skin cancer due to higher sensitivity to UV damage. Darker skin tones have a poorer prognosis if skin cancer develops.

Disease-Related Skin Changes

• Hypothyroidism: Dry, rough skin, coarse hair and nails, hair loss.
• Hyperthyroidism: Warm, soft skin, thin hair, hair loss, vitiligo, pretibial myxedema , hyperpigmentation.
• Diabetes: Acanthosis nigricans, neuropathic ulcers, peripheral vascular disease.
• Liver Disease: Jaundice, spider angiomas, palmar erythema, itching, bruises (purpura).
• Peripheral Vascular Disease: Dry, scaly, shiny skin, brittle nails, cool skin, hair loss, ulcers, pallor, cyanosis, gangrene.

Abnormal Skin Discolorations

• Cyanosis: Bluish discoloration due to decreased oxygenation.
• Jaundice: Yellowish discoloration due to liver dysfunction.

Systemic Lupus Erythematosus (SLE)

• Butterfly Rash: Flat, red, itchy rash across the nose and cheeks that worsens in sunlight.
• Other findings: Inflammatory and autoimmune condition with various skin features.

Vitiligo

• Depigmentation: Localized loss of skin pigmentation.
• Possible cause: Thought to be related to immune system dysfunction.
• Benign: Usually benign though variable presentation.

Health History Inquiry Points

• Rashes: History of rashes.
• Lesions: Any non-healing lesions or changes in moles/birthmarks.
• Bruising (ecchymosis): Determine cause and frequency.
• Hair Loss: Note history and extent
• Nail Changes: Discuss specific changes
• Itching: Note location, severity, and associated factors.
• Medications: Important to identify medications that cause photosensitivity.

Lifestyle and Habits

• Hygiene: Bathing/shampooing routines, skin care, artificial nails, hair extensions.
• Sun Exposure: Daily sun exposure and sunscreen use.
• Skin Self-Exams: Identify if patients perform regular skin self-exams.
• Chemical/Radiation Exposure: Assess exposure to harmful elements.
• Diet: Assess for nutritional deficiencies.
• Piercings/Tattoos: Evaluate risks for infections, allergic reactions, and other complications (e.g., tattoo reactions to MRI).
• Alcohol/Smoking: Discuss potential links to skin conditions.

Inspection Technique

• Privacy and Dignity: Maintain patient privacy.
• Systematic Inspection: Assess both anterior and posterior surfaces thoroughly in good lighting.
• Correlate Findings: Compare skin findings to mucous membrane observations.

Hair Assessment

• Quantity, Distribution, and Texture: Note any changes that could indicate nutritional deficiencies or systemic issues.
• Alopecia: Patchy hair loss.
• Hair Loss on Legs: May be related to peripheral artery disease.
• Hirsutism: Increased hair growth over face, chest, or back that's due to increased male hormones.
• Evaluate for: Lesions, flaking, and parasites

Skin Color Assessment

• Genetic Variation: Skin color varies by ethnicity.
• Assess for Changes: If patients note changes in skin color.
• Discolorations: Identify and document any changes in skin tone, including cyanosis (bluish/dusky) and pallor (pale).
• Pallor: Might indicate anemia or decreased blood flow.
• Central Cyanosis: May indicate underlying lung or heart conditions, requiring oxygen saturation measurement.

This quiz covers the critical aspects of skin assessment, including the importance of thorough inspection for newly admitted or immobile patients. It also explores the layers of skin and the functions of various glands, highlighting the epidermis, dermis, and subcutaneous tissue.