Republic of the Philippines

Mariano Marcos State University

COLLEGE OF HEALTH SCIENCES
City of Batac, Ilocos Norte, 2906 Philippines
Telefax: +6377 7923882; E-mail address: mmsu_chs_2009@yahoo.com
Website: www.mmsu.edu.ph

HEALTH ASSESSMENT
Physical Examination
Skin, Hair and Nails

The skin, which is the largest organ in the body, is essential for human life. It forms
a barrier between the internal organs and the external environment and participates
in many vital body
functions. The skin is contiguous with the mucous membrane at the external openings of the
digestive, respiratory, and urogenital systems.
Assessment of the skin involves the entire skin area, including the mucous membranes,
scalp, hair, and nails. The skin is a reflection of a person’s overall health, and alterations
commonly correspond to disease in other organ systems.

ASSESSMENT OF THE SKIN

 In each area, inspect and palpate for the color,moisture, temperature, texture, turgor, signs of
bleeding, ecchymosis, vascularity and lesions

Color Look for increased pigmentation (brownness), loss of pigmentation, redness, pallor, cyanosis, and
yellowing of the skin.

Lesions note for their characteristics particularly their anatomic location and distribution,color,
arrangement and type

PRIMARY SKIN LESIONS

LESION DESCRIPTION EXAMPLES
Macule Flat, nonpalpable skin color
change(color may be brown, white,
tan, purple, red) which is less than 1
cm in diameter with well
circumscribed border Freckles, flat moles,
Patch petechia, rubella,vitiligo,
port wine stains,
Flat, non palpable skin color
ecchymosis
change(color may be brown, white,
tan, purple, red) which is more than 1
cm in diameter and may have an
irregular border

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Papule
Elevated, palpable, solid mass with a
circumscribed border and is less than Warts, elevated nevi
0.5cm in diameter

Plaque
Elevated, palpable, solid mass with a
circumscribed border and is more than Psoriasis, eczema,
0.5cm in diameter

Nodule, Tumor
Elevated, palpable, solid mass that
extends deeper into the dermis than
a papule:
Nodule: melanoma,
NODULE: 0.5–2 cm in diameter and hemangioma
usually with well circumscribed border
Tumor: Carcinoma
TUMOR: greater than 1–2 cm in
diameter do not always have sharp
Nodule Tumor borders

Vesicle, Bulla
Circumscribed, elevated, palpable
epidermal mass containing serous Vesicle: herpes zoster,
fluid: chickenpox, scabies

VESICLE: less than 0.5 cm in Bulla: Contact

Vesicle Bulla
diameter dermatitis, large second-
degree burns, bullous
BULLA: greater than 0.5 cm in impetigo
diameter

Wheal
An elevated, mass with irregular
borders which may vary in size and
Insect bite, hive,
color; It is usually caused by the
angioedema
movemen tof serous fluid into the
dermis

Pustule

Acne, impetigo,
A pus-filled vesicle or bulla furuncles, carbuncles,
folliculitis

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 SECONDARY SKIN LESIONS
Erosion

Loss of superficial epidermis that does

Ruptured vesicles,
not
scratch marks
extend to dermis; depressed, moist area

Ulcer

Skin loss extending past epidermis Stasis ulcer of venous

extending up to the upper papillary layer insufficiency, pressure
of the dermis Ulcer

Fissure

Linear crack in the skin that may extend Chapped lips or hands,
to dermis athlete’s foot

Scales
Flakes secondary to desquamated, dead
Epithelium that may adhere to skin surface; Dandruff, psoriasis, dry
color varies (silvery, white); texture varies skin, pityriasisrosea
(thick, fine)

Crust

Residue left after vesicle

Dried residue of serum, blood, or pus on skin
rupture: impetigo,
Surface; Large, adherent crust is a scab
herpes, eczema

Scar
Skin mark left after healing of a wound or
lesion; represents replacement by
Healed wound or
connective tissue of the injured tissue
surgical incision
Young scars: red or purple
Mature scars: white or glistening

Keloid

Hypertrophied scar tissue secondary to

Keloid of ear piercing or
excessive collagen formation during healing;
surgical incision
elevated, irregular

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 SKIN LESION ARRANGEMENT AND DISTRIBUTION
Linear (Serpiginous) Annular

Lesions that form a line or snakelike shape Lesions that are arranged in a circular pattern
Discrete Confluent

Lesions that are separate and distinct Lesions that merge and run together
Generalized Zosteriform

Lesions that are scattered over the body Lesions that are arranged along a nerve root

VASCULAR LESIONS
PETECHIA (PL. PETECHIAE) ECCHYMOSIS (PL. ECCHYMOSES)

Round or irregular macular lesions which are

Round red or purple macule which is usually generally larger than petechia; color varies and
about 1-2 mm in diameter usually changes (black, yellow)
CHERRY ANGIOMA SPIDER ANGIOMA

A papular and round lesion which is

usually red or purple in color A red, arteriole lesion which has a central body
with radiating branches

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 ASSESSING FOR SKIN
TURGOR
 Pinch a small section of the patient’s skin
between thumb and forefinger
 Slowly release the patient’s skin
 Observe the speed with which the skin
returns to its original contour when
released
ASSESSING FOR EDEMA
 Firmly imprint thumb against a
dependent
portion of the body (such as the arms, hands, legs,
feet, ankle)
 Release the pressure, observe for indentation on
the skin and rate the degree of edema

 Check for symmetry and measure the

circumference of the affected extremities

ASSESSMENT OF THE NAILS

 Inspect and palpate for the color, shape, configuration and texture of the nails:
o Check for nail grooming and cleanliness
o Note for nail color and markings
o Observe for the shape of the patient’s nails
o Palpate to assess texture and consistency, noting whether nailplate is attached to
nailbed
o Test capillary refill in nailbeds by pressing the nail tip briefly and watching for color
change

COMMON NAIL COLOR ABNORMAL FINDINGS

LEUKONYCHIA LINDSEY’S NAILS
SPLINTER
(Mees Hands) (Hald and Half Nails)
HEMORRHAGES

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 NAIL SHAPES AND CONFIGURATIONS

ASSESSMENT OF THE HAIR

 Accomplished through inspection and palpation:
o Ask the patient to remove hairpins, clips or wigs
o Wear clean gloves if lesions are suspected or if hygiene is poor
o Separate the hair into sections
 Inspect hair for color, amount, and distribution
 Palpate for texture

Alopecia
Hirsutism

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