Assessment of Skin, Hair, and Nails

Assessment of the skin, hair, and nails should be completed as part of a comprehensive assessment or as a focused assessment if your patient is experiencing issues that affect the integumentary system. The methods of skin, hair, and nails assessment include inspection and palpation.

Alright, start with a general inspection of the skin, which should be intact and without discoloration or lesions. Remember to check areas that are not commonly visible, such as the axillae, perineum, and between the toes.

Begin by noting the thickness of the skin, which will vary depending on the body area. For example, calluses can appear on hands and feet due to frequent use, whereas the skin of the eyelids will be thin and delicate.

Also note your patient’s skin color, which will range from shades of black, brown, and tan, to shades of pink and white. These variations in pigmentation are often due to factors like genetics and sun exposure. Remember to consider these natural variations in skin color and tone when assessing your patient’s skin. For example, in patients with lighter skin, rashes may appear pinkish-red, but in patients with darker skin, rashes may appear hyperpigmented or purplish in color. Bruising can appear purple, blue, or green in lighter skin but deep blue or black in darker skin.

Likewise, cyanosis in lighter skin appears blue or purple, while cyanosis in darker skin can appear gray or green, and is more easily seen in the mucous membranes, lips, conjunctiva, and nail beds. Likewise, the yellow discoloration in jaundice can be obvious in those with lighter skin but can be subtle in those with darker skin, so looking at the sclera and palms of the hands may more easily reveal the discoloration.

Some of the lesions you may see during inspection include macules, papules, vesicles, bullae, pustules, and plaques. A macule is a flat lesion, usually less than 1 centimeter in diameter that’s a different pigmentation from the rest of the skin. Examples include freckles and petechiae, which are tiny spots of bleeding under the skin.

In contrast, a papule is an elevated, solid, demarcated lesion that’s less than 1 centimeter in diameter. Examples of papules are warts and some moles.

Then there are vesicles, which are elevated lesions, usually less than 1 centimeter in size, filled with serous fluid. These are typically seen with chickenpox or shingles.

On the other hand, a bulla is a vesicle that’s greater than 1 centimeter; a common example is a blister. Next, pustules are elevated lesions, less than 1 centimeter, and filled with pus. Pustules commonly occur with impetigo or acne. Lastly, plaques are elevated, firm and coarse or scaly lesions that are larger than 1 centimeter, as seen in conditions like psoriasis or seborrheic dermatitis.