ASSESSMENT OF SKIN , HAIR, AND NAILS

SKIN

- Largest organ of the body

- Cover’s the body external surface
- Made up of three layers, the epidermis, dermis, hypodermis
- First physical barrier that the human body has against the external environment.

Functions:

1. Protection against microorganism, dehydration, ultraviolet light, and mechanical

damage.
2. Sensation of pain, temp., ouch, and deep pressure starts with the skin.

3 LAYERS OF THE SKIN

1. Epidermis
- Outer layer of the skin.
- Includes pores, which allow oil and dirt to escape your body.
2. Dermis
- Middle layer of the skin.
- Has connective tissue blood vessels, oil and sweat gland, nerves, hair follicle and
other structures.
3. Hypodermis
- Subcutaneous
- Bottom layer of skin in your body.
- It stores energy, connecting the dermis layer of your skin to your muscles and
bones, insulating your body and protecting your body from harm.
4 TECHNIQUES OF PHYSICAL ASSESSMENT

1. Inspection- use of visual

2. Palpation- use the hand of touch
• Light palpation- check the muscle tone
• Deep palpation- identify abdominal organs ad abdominal masses.
3. Percussion- striking the body surface with short sharp strokes in order to produce
palpable vibration and characteristics sounds.

Percussion Sounds

• Resonance
• Hyper-resonance
• Tympany
• Dullness
• Flatness
4. Auscultation- listening to sounds produced inside the body. It involves listening to
sounds and a stethoscope is mostly use.

ASSESSMENT OF THE SKIN

1. Family History Assessment

2. Physical Assessment
- Assess for related clinical features sparse eyebrows, eyelashes, alopecia, and nail
abnormalities.
- Assess for related alterations in vision, albinism, retinal abnormalities
- Inspection and palpation are commonly used technique.
ABNORMAL SKIN FINDINGS

ASSESSING THE GENERAL APPEARANCE

1. ERYTHEMA- abnormal redness of skin or mucous membranes.

2. HEMANGIOMA- common, benign (non-cancer) growth made of extra blood vessels
in the skin.
3. PORT-WINE STAINS (NEVUS FLAMMEUS)- a flat, pink, red, or purple mark that
appears at birth, often on the face, arms, and legs, and continues to grow as the
child grows.
4. SPIDER ANGIOMA- vascular lesion characterized by anomalous dilation of end
vasculature found just beneath the skin surface.
5. VENOUS LAKE- common bluish soft macule or papule due to vascular dilation. It is
most often seen on the lower lip.
6. MELANOMA- means “black tumor), most dangerous type of skin cancer.
7. PETECHIAE- pinpoint non-blanching spots that measures less than 2 mm size and
affect the skin and mucous membranes.
8. ECCHYMOSIS (BRUISES)- ark on your skin that’s black and blue or red to purple.
9. PURPURA- occurs when a small blood vessels leak blood under the skin.
10. HEMATOMA- solid swelling of clotted blood within body tissues.
SKIN LESIONS

- Part of the skin that has abnormal appearance compared to skin around it.

Primary Lesion- which develop as direct result of disease process.

• Macule and patch- Flat, discolored spots on the skin. A macule is smaller (less
than 1 cm), and a patch is larger (greater than 1 cm).
• Tumor- A large growth on the skin that can be benign (non-cancerous) or
malignant (cancerous).
• Papule- A small, raised bump on the skin, often less than 1 cm in diameter.
• Plaque- A raised, flat-topped lesion, usually larger than 1 cm, that feels rough or
scaly.
• Nodule- A solid, raised bump on the skin that's larger than a papule, usually
more than 1 cm.
• Vesicle and Bullae- Small fluid-filled blisters; vesicles are less than 1 cm, and
bullae are larger than 1 cm.
• Pustule- A small, raised bump filled with pus, often seen in conditions like acne.
• Wheal- A temporary, raised, red or white area on the skin, often itchy, like those
caused by insect bites or hives.
Secondary Lesion- which evolve from primary lesions or develop as a consequence of the
patient’s activities.

• Scales- Thin flakes of dead skin cells that peel off, often seen in conditions like
psoriasis.
• Crust- A dried collection of blood, serum, or pus on the skin's surface, forming a
scab.
• Fissure- A deep crack or split in the skin, often painful, like those seen in
chapped lips.
• Ulcer- A sore that forms when the skin breaks down, exposing underlying tissue,
often slow to heal.
• Scar - A mark left on the skin after a wound or injury has healed, made of fibrous
tissue.
• Atrophy- Thinning or wasting away of the skin, making it look thin and fragile,
often due to aging or certain medical conditions.
VASCULAR LESION

- Relatively common abnormalities of the skin and underlying tissues.

Three major categories:

HEMANGIOMA- most common type of vascular lesion in children. They are benign (non-
cancer), tumors of the cells that lines blood vessels.

VASCULAR MALFORMATIONS- rare conditions affecting the vascular system that develop
before birth

• Venous malformation
• Lymphatic malformation
• Venolymphatic malformation
• Arteriovenous malformation

PYOGENIC GRANULOMAS- benign, raised tumor on skin or mucous membranes.

COMMON SKIN LESION

1. Cyst
- is a sac that could contain fluid, air, or another substance. Any abnormal mass of
tissue or swelling is called a tumor.
2. Skin erosion
- results in a stripped surface if the epidermis, or outer layer, is lost partially or
completely.
3. Lichenification
- is the skin has become thickened and leathery.
4. Scaling skin
- or scaly skin, occurs when the outer layer of your skin peels away in large pieces
that resemble fish scales.
5. Crusting
- is the dry, rusty colored crust that appears over any skin damage 24 hours after
the incident.
6. Skin ulcers
- are open round sores. They develop when blood can't flow to an injury.
Skin fissures are splits in the skin, usually to the point of bleeding.
7. Scar
- is the body's natural way of healing and replacing lost or damaged skin.
8. Tinea
- ringworm of the body.
9. Measles
- A highly contagious viral infection that causes fever, cough, runny nose, inflamed
eyes, and a red, blotchy skin rash.
10. Varicella (chickenpox)
- A viral infection causing itchy, blister-like rashes, fever, and fatigue. It's highly
contagious and common in children.
11. Herpes (herpes simplex virus)
- viral infection causing painful blisters or sores, usually around the mouth (oral
herpes) or genital area (genital herpes).
12. Herpes Zoster (Shingles)
- reactivation of the chickenpox virus in the body, causing a painful, blistering rash
along nerve pathways.
13. Psoriasis
 - chronic skin condition characterized by red, scaly patches on the skin, which can be
itchy and sometimes painful.
14. Contact Dermatitis
- allergic reaction to a substance or direct touch.
15. Eczema
- is a skin condition that causes dry and itchy patches of skin. It's a common
condition that isn't contagious.
16. Impetigo
- primarily affects newborns and young children and is a common and highly
contagious skin ailment.
MALIGNANT LESION
1. Basal cell carcinoma
- most common and least aggressive type of skin cancer, usually appearing as a
small, shiny bump or patch on sun-exposed areas.
2. Squamous cell carcinoma
- more aggressive form of skin cancer that appears as a red, scaly, or crusted patch,
often on sun-exposed areas.
3. Malignant melanoma
- most serious type of skin cancer that develops in the pigment-producing cells
(melanocytes), often appearing as an irregularly shaped, dark-colored mole.
4. Kaposi’s Sarcoma
- rare type of cancer that forms in the lining of blood and lymph vessels, causing
purple, red, or brown patches on the skin or mucous membranes, often associated
with weakened immune systems.
ASSESSMENT OF THE HAIR

HAIR
- protein filament that grows from follicles found in dermis.

FUNCTIONS
1. keep us warm by preserving heat
2. eyebrows and eyelashes protect eyes by decreasing the amount of light and
particles that go into them.
3. Hair in the nose, ears and around the eyes protects these areas from dust and other
small particles.

ABNORMAL HAIR FINDINGS:

Seborrhea "Cradle Cap” - common condition in babies, causing oily, scaly patches on the
scalp.
Tinea Capitis- A fungal infection of the scalp, resulting in itchy, scaly bald patches.
Alopecia Areata- An autoimmune condition causing sudden hair loss in small, round
patches.

Hair Infections:
Folliculitis- Inflammation of hair follicles, usually due to bacterial infection, causing red,
swollen bumps.
Furuncles- Also known as boils, these are deep infections of hair follicles that result in
painful, pus-filled lumps.

Other Conditions:
Hirsutism- Excessive hair growth in women in areas where men typically grow hair, like the
face and chest.
Psoriasis- Although mainly a skin condition, it can affect the scalp, causing scaly, silvery,
and sharply defined patches.

ASSESSMENT OF NAILS

NAILS- accessory organs. Made of sheet dead keratinocytes and are found on the far or
distal ends of the fingers and toes.

FUNCTION:
1. To protect the terminal portions of the toes and fingers
2. The nails assists in the manipulation of small objects, as well as in scratching.

ABNORMAL FINDINGS OF THE NAILS

SPOON NAILS (KOYLONYCHIA)

- Central portion of the nail is depressed and the lateral aspects of the nail are
elevated.

PARONYCHIA
- Infection of the proximal and lateral fingernails and toenails folds, including the
tissue that borders the root and sides of the nail.

SPLINTER HEMORRHAGES
- Look like thin, red or reddish brown lines below your nails.

BEAU’s LINES
- Horizontal ridges or dents in one or more of your fingernails of toe nails.

ONYCHOLYSIS
- When a nail (nail plate) on your fingers or toes separates from the skin on which in
rest (nail bed).