NCM 101

HEALTH
ASSESSMENT
ANNE CELIS, R.N
WEEK 5
GENERAL SURVEY,
ASSESSMENT OF
SKIN, HAIR & NAILS
 1. Review the anatomy and functions of the skin, hair
and nails
2. Interview clients for an accurate nursing history of
the skin hair and nails
3. Discuss Risk Factors for Skin Cancer and
methicillin resistant Staphylococcus aureus infections
4. Use correct techniques to perform physical
LEARNING assessment of the skin, hair and nails
5. Teach a client to perform a self assessment of the
OBJECTIVES skin, hair and nails
6. Differentiate between normal and abnormal
findings of the skin, hair and nails
7. Clearly document and verbally communicate
subjective and objective data findings
8. Recognize how assessment findings may vary in
the older adult
9. Analyze collected subjective and objective data to
make valid nursing judgement
ANATOMY & PHYSIOLOGY
 SKIN
 largest organ of the body.
STRUCTU  protects underlying tissues and organs from
RE & microorgaisms, physical trauma, UVR and
dehydration
FUNCTION  It plays a vital role in temperature maintenance,
fluid and electrolyte balance, absorption,
excretion, sensation and Vit D synthesis.
 THREE LAYERS – epidermis, dermis and
Subcutaneous tissue
 • EPIDERMIS
5 LAYERS : STRATUM CORNEUM, STRATUM LUCIDUM,
STRUCTU STRATUM GRANOLUSUM, STRATUM SPINOSUM &
STRATUM GERMINATIVUM (BASALE)
RE & dead keratinized cells (waterproof)
FUNCTION Replaced every 3-4 weeks
Stratum Germinativum – cell division,
contains melanin (brown pigment and keratin-
forming cells, keratin (protein)
> Capillary blood flow, chromophores
(carotene & lycopene) and collagen
 DERMIS
- Inner layer of the skin
- Dermal Papillae – unique pattern of friction ridges
STRUCTU (fingerprints)
- Well vascularized connective tissue layer containing collagen,
RE & elastic fibers, nerve endings and lymph vessels.
- Sebaceous glands, sweat glands and hair follicles
FUNCTION SEBACEOUS GLANDS
-Secrete oily substance called sebum that
waterproofs the hair and skin
SWEAT GLANDS
-Two types – Apocrine (axillae, perineum & areolae –
body odor )& Eccrine (sweat and thermoregulation)
 SUBCUTANEOUS TISSUE
- Loose connective tissue containing fat, cells, blood
vessels.
- Stores fat as an energy reserve, provides insulation,
STRUCTU serve as cushion to protect bones and internal
organs, supply of nutrients and removal of waste
RE & products to and from the skin.

FUNCTION HAIR
- consist of keratinized cells, found all over the body
except lips, nipples, soles of the feet, palms of the
hands, labia minora and penis
- Hair develops within epidermal cells called hair
follicle (hair shaft & root)
- Arector Pili Muscle – goose flesh (fight or flight)
 TWO TYPES OF
HAIR

STRUCTUR VELLUS HAIR (Peach Fuzz) – short,

pale, fine, present much of the body.
E& > thermoregulation, provides
FUNCTION insulation,

TERMINAL HAIR – scalp and

eyebrows, longer, generally darker
and coarser
 • NAILS
>Distal phalanges of fingers and toes are hard,
transparent plates of keratinized epidermal cells
that grow from the cuticle.
PARTS
STRUCTU 1. Nail Body – extends over the entire the nail
RE & bed and has a pink tinge as a result of blood
vessels underneath.
FUNCTION 2. Lunula – crescent- shaped area located at the
base of the nail.
- The nails protect the distal ends of the fingers,
toes, enhance precise movement of the digits and
allow for an extended precision grip.
SUBJECTIVE DATA :
THE NURSING
HEALTH HISTORY
CURRENT HEALTH
SYMPTOMS
PAST & FAMILY HISTORY
LIFESTYLE & HEALTH
PRACTICES
OVERALL FUNCTIONING
TO SKIN, HAIR & NAILS

HISTORY OF PRESENT HEALTH CONCERN
STRUCTURE & FUNCTION
QUESTION
Current Skin Problems – rashes, lesions, dryness, oiliness, drainage,
bruising, swelling or changes in color, How long have you had this
symptom, What aggravates the problem? What relieves it ? Have
you tried any OTC or been prescribed any medication
Birthmarks or moles? Changed color, size & shape. Warning signs
of Skin Cancer (ABCDEs)
Change in Skin Color ?
Change in ability to feel pain? Pressure? Light ? Touch or
temperature variations ?
Are you experiencing any pain, itching, tingling or numbness
Medications (OTC) creams or ointments, herbal or nutritional
supplements.How long have you been taking
Body Odor ? Excessive Perspiration
RATIONALE
Swelling, bruises or burns – accidents, trauma or abuse
Vague – physical abuse
Obese Clients – dry pruritic skin, stretch marks, skin tags,
dark patches and skin infections
Multiple or atypical mole –increases one’s risk for cancer,
change in the appearance of mole - cancer
Pallor, cyanosis or jaundice
Change in sensation or temperature may indicate
vascular or neurologic problems such as peripheral
neuropathy r/t to DM or AOD. Decreased sensation may
lead to skin infections, impaired skin integrity
Pruritus in dry skin, drug reactions, uremia or jaundice,
allergies, lice, tinea, insect bites,. PARESTHESIA, DIABETIC
PERIPHERAL NEUROPATHY
Photosensitivity Reaction – UV rays, allergic skin reaction
to specific drugs, creams or ointments
Poor hygiene, Hyperhidrosis (sweat glands) –
hypothyroidism and hyperthyroidism (Older adult –
decreases perspiration)
HISTORY OF PRESENT HEALTH CONCERN
STRUCTURE
QUESTION
&
HAIR LOSS – unusual increase in hair
FUNCTION
RATIONALE
ALOPECIA ( patchy hair loss) – infections, stress,
growth or change in condition of your hair. chemotherapy. Generalize hair loss (hyperthyroidism)
Describe Malnutrition, anorexia nervosa and bulimia
Hair Loss, Baldness is common in aging
Hirsutism – increased production of male hormones
Change in condition or appearance of nails Nail Changes in Malnutritrion or with nail biting
Bacterial Infections – green, black, or brown
discoloration
Fungal Infections – Yellow thick, crumbling nails
Yeast Infections – white color, separation of the nail
plate from the nail bed.
6 months – fingernail
12 months – toenails
 PERSONAL HEALTH HISTORY
• Severe sunburns as a child
• Past surgeries, recent hospitalization
• Allergic reactions to food,
medications, plants or
SUBJECT environmental substances
• Recent Viral or bacterial illness
IVE DATA • Pregnant or Menstrual periods
regular
• History of Self Injury – Anxiety &
Depression
 PERSONAL HEALTH HISTORY
• Anyone in family had recent illness,
rash or other skin problems
• Skin Cancer (Malignant melanoma)
• Family history of keloids
SUBJECT
IVE DATA
 LIFESTYLE & HEALTH PRACTICES
• Sunburns/tanning, sunblock - premature aging of skin
• Skin self examination
• Exposed to chemical/iritants
• Sitting/lying in one position
• Exposure to extreme temperature - frostbites/burns
SUBJECT • Body piercings/Tattoos - risk for infection, keloid,
Hepatitis C infection
IVE DATA •
•
Daily routine/products used
History of smoking/drinking alcohol - Psoriasis
• skin disorder -
• Stress
 General survey includes:
Physical development and body build
Gender and sexual development
Apparent age as compared to reported age

ASSESSME Skin condition and color

Dress and hygiene
NT Posture and gait
Level of consciousness
Behavior, body movement and affect
Facial expression
Speech
Vital signs
 • SKIN, HAIR AND NAILS
• Color, pigmentation
• Hydration
• Texture, thickness
OBJECTIV • Turgor, elasticity, mobility
E • Vascularity, erythema,
DATA edema
• Hair distribution, density
• Scalp
• nails
 •1. Prepare the client
•2. Remove all clothing & jewelry
•3. Provide privacy
•4. Ask client to remove nail enamel, artificial nails, wigs,
toupees, or hairpiece as appropriate
•5. Ask client to sit comfortbly
PHYSICAL •6. Make sure room is on a comfortable temperature

ASSESSME •7. Explain procedure

•8. Wear gloves when palpating lesions

NT •9. Ready equipment

KEY POINTS
•1. INSPECT SKIN COLOR, TEMP, MOISTURE, TEXTURE

•2. CHECK SKIN INTEGRITY

•3. BE ALERT FOR SKIN LESIONS
•4. EVALUATE HAIR CONDITION FOR LOSS OR UNUSUAL GROWTH
•5. NOTE NAIL BED CONDITION AND CAPILLARY REFILL
 Table 11.2
Potential
Secondary
Sources for Client
Data Related to
the Skin, Hair,
and Nails
 ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
Inspect SKIN COLOR Evenly colored skin tone without Pallor (loss of color) seen in arterial
unusual or prominent insufficiency, decreased blood
discolorations supply and anemia
Cyanosis – blue tinged in the
perioral bed and conjunctival areas
– Oxygen deficiency; Central
Cyanosis – Cardiopulmonary
problem, Peripheral cyanosis –
vasoconstriction (oral mucosa)
Jaundice – yellow skin tones in the
sclera, oral mucosa, palms and sole

SKIN -
- hepatic dysfunction
Acanthosis Nigricans – linear streak
like pattern in dark skinned people,

INSPECTI suggest DM

ON

Note any SKIN ODOR Slight or no odor of perspiration Strong odor or perspiration may
depending on the activity indicate disorder of the sweat
glands. Poor hygiene practices may
indicate health teachings
 ASSESSMENT NORMAL FINDINGS
Inspect Color Variations Common variations include
suntanned, freckles or white
patches – VITILIGO (different
amounts of melanin in certain
areas
-ALBINISM – generalized loss of
pigmentation
Dark Skinned Clients have lighter
colored palms, soles, nail beds
and lips. Pale or light skinned
clients have darker pigment
around nipples, lips and genetalis
SKIN -
INSPECTI
ON Assess Skin Integrity Skin is intact and there are no
reddened areas.
ABNORMAL FINDINGS
Butterfly (malar rash) across the
bridge of the nose and cheeks –
SLE
Erythema – skin redness and
warmth is seen in inflammation,
allergic reactions or trauma.
Skin breakdown is initially noted
as reddened area on the skin that
may progress to serious and
painful pressure injuries.
Obese – carefully inspect skin on
the limbs inder the breasts and in
the groin area where problems
are frequent due to perspiration
and friction
SKIN - INSPECTION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
Inspect for Lesions Skin is smooth without lesions. Stretch Primary lesions – due to irritations or
> note, symmetry, borders, shape, color, marks (striae) healed scars, freckles, disease.
diameter of lesion and change in lesion moles or birthmarks are common findings Secondary lesions – arise from changes in
over time primary lesions.
> location, distribution and configuration Vascular lesions (reddish-bluish lesions)
are seen with bleeding, venous pressure,
aging, liver disease or pregnancy.
Older clients may have skin lesions For abnormal lesions, distribution maybe
associated with aging including diffuse, localized to one area, or in sun
seborrheic keratosis, senile lentigines, exposed areas.
cherry angiomas, purpura, and cutaneous
tags and horns

SKIN – PALPATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
Palpate skin to assess texture Skin is smooth & even Rough, flaky, dry skin –
hypothyroidism, Obese – often
report dry, itchy skin
Palpate to assess thickness Skin is normally thin but calluses – Very thin skin – arterial insufficiency,
exposed to constant pressure steroid therapy
 ASSESSMENT
If lesions are noted when assessing
skin thickness, put gloves on and
palpate the lesion between the
thumb and index finger for size,
mobility consistency and tenderness.
Observe for drainage and
characteristics
Palpate to assess moisture (check
skinfolds and in unexposed areas)
SKIN –
> Dorsal surface – most accurate
result
PALPATIO
N Palpate to assess temperature
Palpate to assess mobility & turgor –
Ask client to lie down. Using two
fingers gently pinch the skin over the
clavicle.
Mobility – how easily the skin is
pinched
Turgor – skin elasticity and how
quickly the skin returns to its original
shape after being pinched.
NORMAL FINDINGS
No lesions palpated
Skin surfaces vary from moist to dry
depending on the area assessed.
Recent activity or warm
environment may cause increased
moisture
Aging – sebum decreases
production
Skin is normally a warm
temperature
Normally the skin is mobile with
elasticity and returns to original
shape quickly. Recoil is usually
immediate
Aging – less collagen fibers –
sagging or wrinkle
ABNORMAL FINDINGS
Infected lesions maybe tender to
palpate. Nonmobile fixed lesions
maybe cancer
Increased moisture or diaphoresis
(profused sweating) – fever and
hyperthyroidism
Decreased moisture – dehydration
and hyperthyroidism
Cold clammy Skin – hypotension
Cold Skin – hypotension
Cool Skin – arterial disease
Very warm – febrile or
hyperthyroidism
Decrease mobility is seen with edema
Decreased turgor – dehydration
Recoil occurs in less than 2 secs –
moderate DHN; more than 2 secs –
severe DHN, more than 3 secs –
tenting
 ASSESSMENT NORMAL FINDINGS ABNORMAL
SKIN – FINDINGS

PALPATIO Palpate to detect

edema (swelling
Skin rebounds and does
not remain indented
Indentations on the
skin may vary from
N related to
accumulation of
when pressure is
released.
slight to great and
maybe in one area or
fluid In the tissue. all over the body.
 ASSESSMENT
Inspect the scalp and hair for
general color and condition
NORMAL FINDINGS ABNORMAL FINDINGS
Pale blond to black to gray or Patchy gray hair – nutritional
white – determined by the amount deficiency
of melanin present Copper red hair – severe protein
malnutrition

At 1 inch interval, separate the hair
from the scalp and inspect and
palpate the hair and scalp for
cleanliness, dryness or oiliness,
parasites and lesions. Wear gloves
if lesions are suspected or if
hygiene is poor
Scalp is clean and dry. Sparse
dandruff may be visible. Hair is
firm and smooth somewhat
elastic.
Dermatitis – excessive scaliness
Raised lesions – infections or
tumor growth
Dull dry hair – hypothyroidism and
malnutrition
Poor hygiene – client education
Pustules with hair loss – tinea

SCALP &
HAIR
Inspect amount and distribution of scalp, Varying amounts of terminal hair cover
body, axillae and pubic hair the scalp, axillae, body and pubic areas
> Look for unusual growth elsewhere on according to normal gender distribution
the body Fine vellus hair covers the entire body
except for the soles, palms, lips and
nipples.
Normal male pattern balding is
symmetric
Alopecia – hair loss occurs from the
periphery of the scalp and moves to the
center
capitis (ringworm)
Folliculitis – infections of the hair
follicle appear as pustules
surrounded by erythema
Excessive generalized hair loss – infection,
nutritional deficiencies, hormonal
disorders, thyroid or liver disease, drug
toxicity or hepatic or renal failure.
 Chemotherapy or Radiation therapy
 Patchy hair loss – infections of the
scalp, SLE
 Hirsutism – Cushings disease,
Polycystic Ovarian Syndrome,
imbalance of adrenal hormones or
side effect of steroids.
 ASSESSMENT NORMAL FINDINGS
Inspect Nail grooming and Nails are clean and manicured
cleanliness
Inspect nail color and Pink tones should be seen,
markings some longitudinal ridging is
normal, dark skinned clients
may have freckles or
pigmented streaks in nails
NAILS
Inspect shape of nails There is normally a 160 degree Early clubbing (180 degree
angle between the nail base
and the skin
ABNORMAL FINDINGS
Dirty, broken or jagged
fingernails – poor hygiene,
hobby or occupation
Pale/cyanotic nails –
hypoxia/anemia
Splinter hemorrhage – caused
by trauma
Beau lines – acute illness
Yellow discoloration – fungal
infections or Psoriasis
Nail pitting – common in
psoriasis
angle) and late clubbing
(greater than 180 degree angle)
can occur from hypoxia
Spoon nails (concve) - Iron
deficient Anemia
 ASSESSMENT
Palpate Nail to assess
texture
Palpate to assess texture
NAILS - and consistency, noting
whether nail plate is
attached to nail bed
PALPATIO
N
Capillary Test Refill (CRT)
pressing the nail tip briefly
and watching for color
change.
NORMAL FINDINGS ABNORMAL FINDINGS
Nails are hard and Thickened nails (esp
basically immobile. toenails) maybe caused
by decrease circulation
and seen in
ONYCHOMYCOSIS
Pink tone returns PARONYCHIA
immediately to
balnched nail beds
(inflammation) - local
infection
when pressure is Detachment of nail plate
released. from nail bed refill
(ONYCHOLYSIS)
Pink tone returns Slow (greater 2 secs) CRT
immediately to or capillary nail bed refill
blanched nail beds (return of pink tone) with
when pressure is respiratory or
released cardiovascular diseases
that cause HYPOXIA
COMMON VARIATIONS: SKIN VARIATIONS
FRECKLES - flat small macules of pigment that
appear following sun exposure

VITILIGO - depigmentation of the skin

STRIAE (sometimes called stretch marks)

indented streaks that appear on the abdomen,
breasts, hips, buttocks or other places on the
body.
SEBORRHEIC KERATOSIS -warty or crusty
pigmented lesion

SCAR - mark left on the skin by a cut or burn

that has healed

MOLE (also called Nevus) - flat or raised

tan/brownish marking upto 6mm wide.
CUTANEOUS TAG- raised papule with a
depressed center

CUTANEOUS HORN - a protrusion from

the skin consisting of cornified material
organized in the shape of a horn

CHERRY ANGIOMAS - small raised

spots (1-5 mm wide) typically seen with
aging
Abnormal Skin
Findings
• Primary and secondary lesions
• Vascular lesions
• Purpuric lesions
• Infections
• Malignant lesions
• ABCDE Criteria
PRIMARY
SKIN
LESIONS
A macule (less than 1 cm) Patches (more than 1 cm) is a flat,
distinct, discolored area of skin. It usually does not include a change
in skin texture or thickness.

Ex : freckles, flat moles, petechiae, rubella, vitiligo, port wine stains

and ecchymosis

Vesicle circumscribed elevated palpable mass containing serous

fluid (less than 0.5cm) herpes simplex, chicken pox

Bulla more than 0.5cm a large blister containing serous fluid ex :

dermatitis, large burn blisters, impetigo

.
Papule a small, raised, solid pimple or swelling, often forming part
of a rash on the skin and typically inflamed but not producing pus
(less than 0.5cm) ex elevated nevi, warts
Plaque flat or appear as a thickened area of the skin that isn't
visibly elevated (greater than 0.5cm) ex : psoriasis

Nodule a small swelling circumscribed or aggregation of cells in

the body, especially an abnormal one deeper into dermis than a
papule (0.5 - 2 cm) ex : keloid, lipoma, SCC

Tumor a swelling of a part of the body, generally without

inflammation, caused by an abnormal growth of tissue, whether
benign or malignant.(greater than 1-2cm) ex : carcinoma
Wheal
a red, swollen mark left on flesh by a blow or pressure
an area of the skin which is temporarily raised, typically
reddened, and usually accompanied by itching ex : vesicles
and insect bites

PUSTULE
a small blister or pimple on the skin containing pus.
a small inflamed elevated area of skin containing pus ex:
acne
CYST
A closed, sac-like pocket of tissue that can
form anywhere in the body ex : sebaceous
cyst
SECONDARY
SKIN
LESIONS
 Erosion breakdown of the outer layers of the skin
(epidermis), usually because of a: Cut. Scrape,
inflammation. Ex : rupture vesicle

Scar a mark left on the skin by a cut or burn that has

healed
 Fissure linear crack in the skin that may extend to the dermis and maybe painful ex chapped lips or hands
and athletes foot.

Ulcer – Skin Loss extending past epidermis with necrotic tissue loss. Bleeding and scarring are possible.

Pressure ulcers are also known as bedsores and decubitus ulcers. They range from closed to open wounds
and are classified into a series of four stages based on how deep the wound is:

Stage 1 ulcers have not yet broken through the skin.

Stage 2 ulcers have a break in the top two layers of skin.
Stage 3 ulcers affect the top two layers of skin, as well as fatty tissue.
Stage 4 ulcers are deep wounds that may impact muscle, tendons,igaments, and bone.
Crust A dried exudate on the skin surface, either
serum, blood or pus or a combination
- where the exudate from erosions and ulcers dries
on the surface of the lesion.

Lichenification a secondary skin lesion wherein

the characteristic features of skin thickening,
hyperpigmentation, and exaggerated skin lines are
noted.
Crust A dried exudate on the skin surface, either
serum, blood or pus or a combination
- where the exudate from erosions and ulcers dries
on the surface of the lesion.

Lichenification a secondary skin lesion wherein

the characteristic features of skin thickening,
hyperpigmentation, and exaggerated skin lines are
noted.
Scales a thick, dry flake of skin.

Atrophy decrease in size or wasting away

of a body part or tissue
VASCULAR & PURPURIC
SKIN LESIONS
HEMANGIOMA/INFANTILE HEMANGIOMA
“ Strawberry mark”
Bright Red birthmark that shows up at birth or in the first
or second week of life.

PORT-WINE STAIN (Nevus Flammeus).

Stork bite, is a congenital capillary malformation present
in newborns. It is a common type of birthmark in a
newborn.
Spider (star) angioma.
also known as spider naevus or spider telangiectasia,
is a vascular lesion characterized by anomalous dilatation of end
vasculature found just beneath the skin surface. The lesion contains
a central, red spot and reddish extensions which radiate outward
like a spider's web. They may appear as multiple or solitary lesions.

A spider angioma has 3 features: a body, legs, and surrounding

erythema. The body appears as a 1 to 10 mm central arteriole
visible as a punctum or eminence. It is typically painless, resembles
a spider's body), and is surrounded by attenuated capillaries
radiating in a spider-legged fashion, decreasing in size toward the
margins.

Venous lake
a soft, squashable, blue or purple macule or papule, that is 0.2–1
cm in diameter. Although they may arise anywhere, most venous
lakes are diagnosed on the lower lip (on the vermilion margin or
mucosal surface), on an earlobe, or elsewhere on the face, neck, or
upper trunk..
Petechiae.
pinpoint, round spots that appear on the skin
as a result of bleeding. The bleeding causes the
petechiae to appear red, brown or purple.
Petechiae (puh-TEE-kee-ee) commonly appear
in clusters and may look like a rash. Usually flat
to the touch, petechiae don't lose color when
you press on them.

Purpura.
purple-colored spots and patches that occur
on the skin, and in mucus membranes,
including the lining of the mouth
Ecchymosis (bruise)
A small bruise caused by blood leaking from broken blood
vessels into the tissues of the skin or mucous membranes.
Associated with trauma and bleeding tendencies.

Hematoma
A localized collection of blood creating an elevated
ecchymosis. It is associated with trauma. A
hematoma is usually caused by a broken blood
vessel that was damaged by surgery or an injury. It
can occur anywhere in the body, including the brain.
Telangiectasis (Venous Star)
Bluish or red lesion with varying shape (spider- like or
linear) found on the legs and anterior chest. It does
not blanch when pressure is applied. It is secondary to
superficial dilation of venous vessels and capillaries
and associated with venous pressure states.

Cherry Angioma
Papular and round red purple lesion found on
the trunk or extremities. It may be blanch with
pressure. It is a normal age related skin and
usually not clinically significant
 • Tinea
• Measles
• Varicella
SKIN • Herpes
DISORDERS • Psoriasis
• Dermatitis
• Eczema
• Impetigo
Tinea corporis Ringworm of the body (tinea
corporis) is a rash caused by a fungal infection. It's
usually an itchy, circular rash with clearer skin in the
middle. Ringworm gets its name because of its
appearance

Measles (rubeola) It usually begins as flat red spots

that appear on the face at the hairline and spread
downward to the neck, trunk, arms, legs, and feet.
Small raised bumps may also appear on top of the flat
red spots.
German measles (rubella) a rash that starts on the
face and spreads to the rest of the body.

Chickenpox (varicella) a rash that turns into

itchy, fluid-filled blisters that eventually turn
into scabs.
Herpes simplex A cluster (usually more
than one) of clear, fluid-filled blisters
that may be surrounded by redness --
these blisters may or may not be painful.
Blisters and lesions usually heal within
7 to 10 days. People with HSV-1
infection are infected for life, may have
periodic outbreaks, and can transmit the
virus to others.

Psoriasis
Rashes that vary in color, tending to be
shades of purple with gray scale on
brown or Black skin and pink or red
with silver scale on white skin. Small
scaling spots (commonly seen in
children) Dry, cracked skin that may
bleed. Itching, burning or soreness.
 Herpes zoster (shingles) grouped vesicles on
a red base in a unilateral, dermatomal
distribution.
The lesions of herpes zoster progress through
stages, beginning as red macules and papules
that, in the course of 7-10 days, evolve into
vesicles and form pustules and crusts (scabs).

Contact dermatitis
an itchy rash caused by direct contact with
a substance or an allergic reaction to it. The
rash isn't contagious, but it can be very
uncomfortable. Many substances can cause
this reaction, such as cosmetics, fragrances,
jewelry and plants. The rash often shows up
within days of exposure.
 Eczema (atopic dermatitis)
a chronic (long-lasting) disease that causes
inflammation, redness, and irritation of the
skin. It is a common condition that usually
begins in childhood; however, anyone can get
the disease at any age.

Impetigo starts as a red, itchy sore. As it heals,

a crusty, yellow or “honey-colored” scab forms
over the sore. Symptoms include red, itchy
sores that break open and leak a clear fluid or
pus for a few days. Next, a crusty yellow or
“honey-colored” scab forms over the sore,
which then heals without leaving a scar.
Malignant Lesions

Squamous
Basal cell Malignant Kaposi’s
cell
carcinoma melanoma sarcoma
carcinoma
Figure 11.22 ABCDE Criteria for Melanoma Assessment
Basal cell carcinoma
A shiny, skin-colored bump
that's translucent, meaning you
can see a bit through the
surface. The bump can look
pearly white or pink on white
skin. On brown and Black skin,
the bump often looks brown or
glossy black. Tiny blood vessels
might be visible, though they
may be difficult to see on brown
and Black skin
Squamous cell carcinoma
scaly red patches, open sores,
rough, thickened or wart-like
skin, or raised growths with a
central depression. At times,
SCCs may crust over, itch or
bleed. The lesions most
commonly arise in sun-
exposed areas of the body.
SCCs can also occur in other
areas of the body, including
the genitals.
Malignant melanoma first sign of
melanoma is often a mole that
changes size, shape or color. This
melanoma shows color variations
and an irregular border, both of
which are melanoma warning signs.
Melanomas can develop anywhere
on your body.
Kaposi’s sarcoma typically
appear as painless purplish
spots on the legs, feet or face.
Lesions can also appear in the
genital area, mouth or lymph
nodes.
HAIR DISORDERS
TRACTION ALOPECIA
occurs in individuals having hairstyles that produce a continuous pulling
force on the hair roots.

ALOPECIA TOTALIS
a chronic condition of complete hair loss of the scalp

Alopecia areata
is a disease that develops when the body’s immune system attacks hair
follicles (what holds the hair in place), causing hair loss. You can lose hair
anywhere on your body, including your scalp, inside your nose, and in your
ears. Some people lose their eyelashes or eyebrows.
 HAIR DISORDERS

TRACTION ALOPECIA
occurs in individuals having hairstyles
that produce a continuous pulling force on the hair roots.

ALOPECIA TOTALIS
a chronic condition of complete hair loss of the scalp
 • Seborrhea
• Tinea capitis
Abnormal • Alopecia areata
Hair • Infection
Findings • Folliculitis
• Furuncles
• Hirsutism
Seborrheic dermatitis (cradle cap)
Scaly patches on a baby's scalp. Cradle cap isn't
serious, but it can cause thick crusting and white or
yellow scales. Some babies can also have seborrheic
dermatitis in the diaper area, and on the face, neck,
and trunk. Cradle cap usually clears up within the first
year.

Ringworm of the scalp (tinea capitis)

is a rash caused by a fungal infection. It usually causes
itchy, scaly, bald patches on the head. Ringworm gets
its name because of its circular appearance. No worm
is involved. Ringworm of the scalp is a contagious
infection.
Alopecia areata is a disease that happens when the
immune system attacks hair follicles and causes hair
loss. Hair follicles are the structures in skin that form
hair. While hair can be lost from any part of the body,
alopecia areata usually affects the head and face.

HIRSUTISM
is a condition in women that results in excessive
growth of dark or coarse hair in a male-like pattern
— face, chest and back. With hirsutism, extra hair
growth often arises from excess male hormones
(androgens), primarily testosterone.
Folliculitis
a common skin condition that happens when hair
follicles become inflamed. It's often caused by an
infection with bacteria. At first it may look like
small pimples around the tiny pockets from where
each hair grows (hair follicles). The condition can
be itchy, sore and embarrassing.

Furuncle/abscess
A skin abscess happens when pus collects in
hair follicles, skin tissues, or under the skin. A
furuncle, also known as a boil, is a painful
infection that forms around a hair follicle and
contains pus.
 • Spoon nails
Abnormal • Paronychia
Nail • Beau’s line
Findings • Splinter hemorrhage
• Onycholysis
Spoon nails (Koilonychia) soft nails that look
scooped out. The depression usually is large
enough to hold a drop of liquid. Often, spoon
nails are a sign of iron deficiency anemia or a
liver condition known as hemochromatosis, in
which your body absorbs too much iron from
the food you eat.

PARONYCHIA
is an infection of the skin around a fingernail
or toenail. The infected area can become
swollen, red, and painful, and a pus-filled
blister (abscess) may form. Most of the time,
paronychia is not serious and can be treated
at home.
Beau's lines are horizontal ridges or
dents in one or more of your fingernails
or toenails. They're a sign that an illness,
injury or skin condition interrupted your nail
growth. Treating the underlying cause will
allow new, smoot.h nails to grow again

Splinter hemorrhages look like thin, red to

reddish-brown lines of blood under the
nails. They run in the direction of nail
growth. They are named splinter
hemorrhages because they look like a
splinter under the fingernail. The
hemorrhages may be caused by tiny clots
that damage the small capillaries under the
nails
Onycholysis is when your nail separates from
its nail bed. It often appears after an injury
to your nail, but it may have other causes,
including fungi.

Pitting Nails – seen with Psoriasis

Nail pitting is when you have tiny dents in
your fingernails or toenails.
 Special Considerations
Developmental, Psychosocial, Cultural, and Environmental
 • Pediatric
• Newborn skin is covered with vernix caseosa.
• Infants have skin that is thin, soft, and free of
Developmental terminal hair.
Considerations • Milia and “Stork bites” are common, harmless
markings in newborns
• Infants may be born with lanugo present
• Temperature regulation is inefficient in infants.
Figure 11.3 Milia.
Figure 11.4 Mongolian spots.
 • Pregnant Female
Developmental • Skin pigmentation increases.
Considerations • Development of melasma and the linea nigra are
common
Figure 11.6 Melasma.
Figure 11.7 Linea nigra.
 • Geriatric
• Skin elasticity decreases with aging
• Sebum production decreases and causes dryness
Developmental • Perspiration decreases
Considerations • Decrease in melanin production resulting in
graying hair
• Increased sensitivity to sunlight
• Nails tend to become thicker and more brittle
Figure 11.8 Tenting. A. Step 1: Nurse grasps the skin.

A
Figure 11.8 (continued) Tenting. B. Step 2: Nurse releases grasp, tenting present.

B
 • Stress-induced illnesses
Psychosocial
• Visible skin disorders and self-esteem/body
Considerations image
Cultural and • Religion
Environmental • Birth anomalies
Considerations • Dietary deficiencies
Table 11.1 Color Variations in
Light and Dark Skin
Table 11.1 Color Variations in Light and
Dark Skin (continued)
Table 11.1 Color Variations in Light and
Dark Skin (continued)
Box 11.1 Coining,
Cupping, Pinching