Integumentary (Skin, Hair, Nail)
Exam
INTEGUMENTARY (SKIN, HAIR, NAIL) EXAM FINDINGS
Terminology for Assessment
Functions of the Skin Environmental protection Maintenance of fluids Temperature regulation Sensation Communication Synthesis of Vitamin D
Excrete sweat, urea, and lactic acid Assi...
Terminology for Assessment
Functions of the Skin Environmental protection
Maintenance of fluids
Temperature regulation
Sensation
Communication
Synthesis of Vitamin D
Excrete sweat, urea, and lactic acid
Assist in regulation of blood pressure
History General HPI questions
Skin care habits
• Soap, cleansing routine, oils, lotions, cosmetics, home remedies
Recent activities:
• Anything new
Environmental or occupational hazards
• Dyes, chemicals, plants, water immersion, sun exposure, toxic substances
Recent psychological or physiological stress
General constitutional and other symptoms
Past Medical and Family History Previous skin problems History of allergies
Tolerance to sun Skin cancer
Systemic disease Psoriasis
• Cardiac Infestations
• Renal Infections
• Liver Medications
Exam
Equipment Adequate lighting
Centimeter ruler
Magnifying glass
Gloves!!!!!
Wood’s light
• Useful for identifying fungal infections which will often fluoresce blue-green
Observing and describing lesions Color
Size (measure): use metric measurements
Elevation: raised, flat
Feel: soft, hard, fluid-filled, immobile, rough smooth
Shape
Distribution
Onset/duration
Primary and secondary characteristics
• Primary:
o Arise from previously normal skin
• Secondary:
o Arise from change in primary lesion
o May see loss of skin or gathering of material on
skin. Skin symptoms (itch, burn, dryness. Etc.)
, Primary Characteristics of Lesions
Macule Flat Pustule Vesicle filled with
Non-palpable lesion purulent fluid
Nothing raised, flush
to skin
< 1 cm in diameter
Patch Flat Bulla Vesicle
Non-palpable > 0.5cm in diameter
> 1 cm in diameter
Papule Solid Nodule > 0.5 cm
(not fluid filled) Both width and
Elevated lesion depth
< 0.5 cm in diameter
Plaque Elevated lesion Cyst Nodule containing a
> 0.5 cm in diameter liquid or semisolid
Minimal depth which can be
expressed
Wheal Transitory papule or Tumor Solid lesion
plaque due to edema > 2 cm in both width
of the dermis and depth
(comes and goes)
Vesicle Blister Lichenification Resembles fish scales
< 0.5cm in diameter Due to chronic
Filled with clear fluid irritation
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