Skin, Nail, Hair Assessment

Skin, Nail, Hair Assessment Overview

• The lecture covers subjective and objective data collection, techniques and normal findings, and documentation for skin, nail and hair assessments.

Subjective Data Collection

• Includes questions to assess history and risks related to skin conditions.
• Family history assessment involves inquiring about first-degree relatives with a history of melanoma.
• Questions include whether any relatives had the problem and if they have multiple dark, irregular moles.
• Past history assessment includes asking about skin self-examination habits.
• Inquire about the date of the last clinical skin examination.
• It's important to ask about any pigmented skin lesions, noting their quantity, location, and changes in itching, bleeding, or size
• History of severe sunburns during youth should be considered
• It's important to ask how long the patient can be in the sun before their skin begins to turn red.
• Ask about a history of skin cancer, including when and where, and how it was treated, as well as organ transplants, HIV/AIDS, chemotherapy, or radiation therapy.
• Medications, allergies to medications, latex, nuts, bees, or other items, reactions to allergies, and sunscreen use should be discussed.
• Evaluate lifestyle, occupational history, and personal behaviors.
• Discuss occupation, hobbies, exposure to sunlight or radiation, and protective measures taken against sun exposure.
• Assess the risk for skin breakdown, including diabetes mellitus, peripheral vascular disease, or sensory loss presence.

Objective Data Collection

• Equipment needed includes an examination gown, tape measure, adequate light source, and magnifying glass.

Techniques and Normal Findings - Inspection

• Involves inspecting all body areas, starting with the head and progressing to the feet.
• Part hair to visualize the scalp
• Toes must be separated to assess the soles.
• Note general skin color.
• Normal findings include consistent body pigmentation, with dark-skinned patients potentially having hypopigmented palms and soles.
• Inspect for lesions
• Identify their morphology, configuration, distribution pattern, size, and exact location.
• Common benign lesions include freckles, birthmarks, skin tags, moles, and cherry angiomas.

Lesion Configurations

• Annular lesions are ring-like and circular.
• Arciform lesions are half-ring shaped.
• Linear lesions are line-shaped.
• Polymorphous lesions have several different shapes.
• Serpiginous lesions are curving and snake-like.
• Nummular or discoid lesions are coin-shaped.
• Umbilicated lesions have a central depression.
• Punctuate lesions are small and marked with points or dots.
• Filiform lesions are papilla-like or finger-like projections similar to tongue papillae.

Lesion Distribution Patterns

• Asymmetric distribution affects only one side of the body.
• Diffuse distribution spreads widely across the affected area without a pattern.
• Symmetric distribution affects both sides of the body equally.
• Localized refers to a distinct area.

Primary and Secondary Skin Lesions

• Primary skin lesions are present at the onset of a disease.
• Secondary skin lesions evolve from primary lesions because of disease progression, manipulation, or treatment.
• Primary skin lesion examples include macules, papules, patches, plaques, nodules, vesicles, and bullae.
• Secondary skin lesion examples include ulcers, crusts, atrophy, scars, erosion, and fissures.

Skin Tumors and Growths

• Lipomas are tumors comprising fat cells commonly found on the back of the neck, torso, arms, and legs
• Lentigines are benign, acquired, circumscribed, pigmented macules found on sun-exposed skin.
• Squamous cell carcinoma, related to actinic keratosis and sun exposure, presents as papular, nodular, or plaque-like lesions.
• Kaposi sarcoma, opportunistic in impaired immune status, manifests lesions on the nose, penis, and extremities.
• Basal cell carcinoma is a nodular or papular skin cancer with a pearly border and spider veins, growing slowly and rarely metastasizing.

Techniques and Normal Findings-Inspection (Continued)

• Inspect any wounds or incisions, noting shape, length, width, and depth.
• Use infection-control principles if infection is suspected
• Insert a cotton applicator to measure depth if the wound is deep or tunneled.
• Describe wounds related to trauma, assessing blood supply and noting bleeding or bruising.
• Identify the risk for skin breakdown, especially in hospitalized or inactive patients.
• Classify the wound as partial or full-thickness, and identify the stage if a pressure ulcer is present.
• Monitor the size, depth, diameter, margins, and condition of surrounding tissues, and any drainage, odor, or necrotic tissue.
• Describe the color and texture of the tissue, and identify the amount, color, consistency, and odor of exudate.

Techniques and Normal Findings-Inspection of Nails

• Inspect each fingernail and toenail for color, thickness, and consistency.
• Normal nails are smooth, translucent, and consistent in color and thickness.
• Longitudinal ridging is common in aging patients.
• Longitudinal pigmentation is normal in dark-skinned patients.
• Assess the nail angle by having the patient place the fingernails of both index fingers together.
• A diamond-shaped opening indicates a nail angle of at least 160 degrees.

Abnormal Nail Findings

• Koilonychia (spoon nails) are concave and may be normal in infants, or due to trauma, iron-deficiency anemia, or hemochromatosis.
• Pitted nails arise from psoriatic lesions.
• Longitudinal ridging is, typically a normal variation, especially in elderly.
• Yellow nails can indicate jaundice.
• Clubbing indicates chronic hypoxia.
• Beau's lines indicate slowed or halted nail growth.

Techniques and Normal Findings-Inspection of Hair

• Inspect the hair noting color, consistency, distribution, areas of hair loss, and condition.
• Note areas of decreased or absent hair, ensure hair is equally and symmetrically distributed across the scalp
• Observe the scalp skin for lesions or color changes and ensure it's of consistent color with the rest of the body.

Abnormal Hair Finding

• Alopecia Areata an autoimmune disorder that has noninflammatory loss of hair in a circumscribed distribution.

Techniques and Normal Findings - Palpation

• Use the dorsal surface of the hands to assess skin temperature, ensuring it's warm or cool and appropriate to the environment.
• Use the palmar surface of the fingers and hands to palpate skin moisture and texture, ensuring it's consistent throughout with evenly smooth skin texture.
• Assess skin turgor by gently grasping a fold of the patient's skin between the fingers and ensure skin promptly recoils to its normal position.
• Assess for vascularity by applying direct pressure and evaluating the return of color.
• Check nails for tenderness, mobility, and consistency, and if the lateral and proximal folds are non-tender and non-swollen.
• Palpate the hair by grasping 10 to 12 hairs and check how easily they pull out.

Documentation of Normal Subjective and Objective Findings

• The patient denies pruritus, skin lesions, and excessive dryness, as well as Denies changes to existing moles.
• Skin even colored, smooth, soft, warm, with intact turgor.
• Hair smooth texture, symmetrical distributed on the scalp, consistent coloration and hydration, without evidence of excessive breakage or loss.
• Scalp with consistent pigmentation, no lesions noted.
• Nails smooth and translucent, lateral and proximal folds without swelling or erythema.