Physical Exam: Skin

General Appearance - Inspection
I. Color

• Varies with body part, and from person to person
• Color ranges: "white" skin - ivory or light pink to ruddy pink; dark skin - light to dark brown or olive

II. Alterations in Skin Color

• Hyperpigmentation
• Hypopigmentation
• Cyanosis
• Jaundice
• Erythema

III. Moisture

IV. Temperature

V. Texture: Varies from part to part

• Smooth or rough
• Supple or tight
• Indurated

VI. Turgor

• Normally decreases with age
• Decreased in dehydration

VII. Vascularity

• In older people. capillaries are more fragile
• Petechiae

VIII. Edema

IX. Lesions

• Normal Finding: free of lesions
• Age-related changes include keratosis senilis, cherry angiomas, and atrophic warts
• Primary Lesions:

1. Macule - discolored spot or patch on the skin, neither elevated nor depressed, of various colors, sizes, and shapes
2. Papule - small, red, elevated area on the skin, solid and circumscribed; a pimple
3. Patch - small circumscribed area distinct from the surrounding surface in character and appearance
4. Plaque - patch on the skin or on a mucous surface
5. Vesicle - small sac or bladder containing fluid; a blisterlike small elevation on the skin containing serous fluid
6. Bulla - large blister or skin vesicle filled with fluid; a bleb
7. Pustule - small elevation of the skin filled with lymph or pus
8. Nodule - small node

• Secondary Lesions: (arise from primary)

1. scale
2. crust
3. lichenification
4. scar
5. excoriation
6. ulcer
7. fissure
8. keloid
9. erosion

• For every lesions, note eight (8) aspects

1. color
2. location
3. texture
4. size
5. shape
6. type
7. grouping
8. distribution

X. Hair

• Hirsutism
• Alopecia

XI. Nails

XII. Factors Affecting Skin Condition

• Hygiene
• Nutritional status
• Underlying disorders

XIII. Geriatric Changes in Skin (besides wrinkling, and loss/graying of both head and body hair)

• Thinner skin
• More freckles
• Hypopigmented patches
• Skin is drier, especially on lower extremities
• Less perspiration
• All skin becomes less elastic; hanging parts sag
• Toenails may be thick, distorted and yellowish
• Lesions: cherry angiomas, senile keratosis, atrophic warts