Skin Layers: Epidermis and Dermis

Preparing the Client for Skin, Hair, and Nails Assessment

• Ask the client to remove all clothing and jewelry and put on an examination gown.
• Ensure the client's privacy and comfort.
• Make sure the room is at a comfortable temperature.
• Wash hands before the examination.
• Explain the procedure to the client.
• Wear gloves when palpating.

Equipments for Skin, Hair, and Nails Assessment

• Examination light
• Penlight
• Mirror for client's self-examination of the skin
• Magnifying glass
• Centimeter ruler
• Gloves
• Examination gown or drape

Skin Assessment

• Epidermis: the outer layer of the skin, composed of 4 layers (stratum corneum, stratum lucidum, stratum granulosum, stratum germinativum).
• Dermis: the inner layer of the skin, connected to the epidermis by papillae.
• Sebaceous glands: develop from hair follicles, secrete sebum that lubricates hair and skin.
• Sweat glands: two types (eccrine and apocrine).
• Subcutaneous tissue: loose connective tissue containing fat cells, blood vessels, nerves, and sweat glands.

Abnormal Skin Findings

• Pallor: loss of color
• Cyanosis: makes white skin appear blue-tinged
• Central Cyanosis: results from a cardiopulmonary problem
• Peripheral Cyanosis: may be a local problem resulting from vasoconstriction
• Jaundice: characterized by yellow skin tones
• Acanthosis Nigricans: roughening and darkening of skin in localized areas
• Albinism: generalized loss of pigmentation
• Erythema: skin redness and warmth, seen in inflammation
• Early Clubbing: 180° angle with spongy sensation
• Late Clubbing:

Hair Assessment

• Consists of many layers of keratinized cells
• Develops within a sheath of epidermal cells called hair follicle
• Two types of hair: vellus hair (short, pale, and fine) and terminal hair (longer, generally darker, and coarser)

Nail Assessment

• Located on the distal phalanges of fingers and toes
• Hard, transparent plates of keratinized epidermal cells
• Grows from a root underneath the skin fold called the cuticle

Common Skin Variations

• Freckles: flat, small macules of pigment that appear following sun exposure
• Striae: stretch marks
• Scar: marks after healed wounds or lesions
• Vitiligo: benign acquired skin disease of unknown cause
• Seborrheic Keratosis: warty crusty pigmented lesions
• Mole: flat or raised tan/brownish marking
• Cutaneous Tags: raised small yellow papules with a depressed center
• Cherry Angiomas: small, raised red spots seen with aging
• Ulcer: skin loss extending past epidermis
• Crust: dried residue
• Keloid: hypertrophied scar tissue
• Petechiae: round or red purple macule
• Hematoma: a localized collection of blood

Common Nail Disorders

• Beau's Lines: acute illness
• Spoon Nails: from deficiency anemia/koilonychia
• Early Clubbing: oxygen deficiency
• Pitting: psoriasis
• Paronychia: local infection

COLDSPA Mnemonic

• C: Characteristics
• O: Onset
• L: Location
• D: Duration
• S: Severity
• P: Pattern
• A: Associated Factors