Skin, Hair, and Nail Assessment

Skin, Hair, Nail Assessment

• Focuses on subjective and objective data collection
• Covers techniques and normal findings for inspection and palpation
• Includes documenting normal subjective and objective skin findings

Subjective Data Collection

• Involves questions to assess history and risks related to skin conditions

Family History

• Includes questions about family members with melanoma and unusual moles

Past History

• Includes questions about skin self-exams, skin lesions, sunburns, and skin cancer

Medications and Allergies

• Includes what medications being taken and allergies that may be contributing to lesions

Lifestyle and Risk Factors

• Includes questions related to occupation, hobbies, sun exposure, and personal behaviors that relates to skin conditions or breakdown

Objective Data Collection

• Includes equipment needed, the examination gown, tape measure, adequate light source and magnifying glass

Technique and Normal Findings - Inspection

• Key element of the health assessment

Procedure

• Involves inspecting all body areas, starting with the head and progressing to the feet
• It is important to visualize the scalp and separate the toes
• Includes evaluating skin color and documenting findings

Normal Findings

• Body Pigmentation is consistent with no abnormalities and patients with dark skin may have hypopigmented palms and soles.

Abnormal Findings

• Involves identifying skin lesions and documenting their morphology, configuration, distribution pattern, size, and exact location

Lesion Configurations

• Annular lesions are ring-like and circular in shape
• Arciform lesions are half-ring shaped
• Linear lesions are line-shaped
• Polymorphous lesions have several different shapes
• Serpiginous lesions are curving, snake-like
• Nummular/Discoid lesions are coin-shaped
• Umbilicated lesions have a central depression
• Punctuate lesions are small, marked with points or dots
• Filiform lesions are papilla-like or finger-like

Lesion Distribution Patterns

• Asymmetric distribution occurs solely on one side of the body
• Diffuse distribution occurs widely across an area without any pattern
• Localized distribution occurs at a distinct area
• Symmetric distribution occurs equally on both sides of the body

Primary and Secondary Skin Lesions

• Primary skin lesions appear at the onset of a disease
• Secondary skin lesions result from changes over time caused by the disease

Examples of Primary Skin Lesions

• Macules
• Papules
• Patches
• Plaques
• Nodules
• Vesicles
• Bullae

Examples of Secondary Skin Lesions

• Ulcers
• Crusts
• Atrophy
• Scars
• Erosions
• Fissures

Skin Tumors and Growths

• Lipomas are tumors comprising fat cells
• Lentigines are pigmented macules found on sun-exposed skin
• Squamous cell carcinoma is related to actinic keratosis and sun exposure
• Kaposi sarcoma is a consequence of impaired immune status
• Basal cell carcinoma appears shiny with a rolled border and spider veins

Technique and Normal Findings - Additional Inspection Techniques

• Inspect for infections and inflammatory lesions
• Observe growths, tumors, wounds, and incisions
• Describe wounds related to trauma by noting skin color, surface temperature and measuring.
• Identify risk for skin breakdown, especially in hospitalized patients
• Identifying the wound as partial or full thickness and identifying the stage of the ulcer.
• Classify the wound by its depth, diameter, surrounding tissues, drainage,odor, and necrotic tissue

Technique and Normal Findings - Nails

• Inspect for irregularities in fingernails and toenails
• Observe color, thickness, and consistency
• Examine nail angles, longitudinal ridging, and pigmentation

Abnormal Nail Findings

• Spoon nails
• Pitted nails
• Longitudinal ridging
• Yellow nails
• Clubbing
• Beau's lines

Technique and Normal Findings - Hair

• Inspect hair for irregularities in color, condition, consistency, and distribution

Normal hair

• Is evenly and symmetrically distributed across the scalp

Abnormal Hair Findings

• Alopecia Areata, which results in noninflammatory hair loss

Technique and Normal Findings - Palpation

• Using the dorsal and palmar surface of the hands to assess skin texture, moisture and temperature

Technique and Normal Findings - Skin Turgor

• Assess skin turgor
• Recoiling of skin promptly is a good sign

Skin Characteristics

• Nails should be smooth, nontender, with unswollen lateral and proximal folds
• Should be able to gently pull at least 10 hairs without them coming out

Documentation of Normal Subjective and Objective Findings

• The patient denies pruritus, skin lesions and excessive dryness of the skin
• There are no changes to moles, is evenly colored, smooth, soft, consistently warm, with intact turgor and no suspicious lesions

General findings

• Nails are smooth and translucent
• There is no scalp swelling or erythema
• Hair texture is smooth, symmetrically distributed with consistent coloration and hydration and with no lesions noted