FACULTY OF NAUROPATHY & YOGA SCIENCE

GENERAL EXAMINATION OF SKIN, HAIR AND NAILS

PRESENT BY ROSHNI & SPARSH

BNYS 2ND YEAR
 SKIN STRUCTURE
 The skin is the largest organ in the body surface
area of about 1.5-2 square meters in adults.

 It contains accessory structures like Hair,

glands, & nails.

 Its has Three layers ; epidermis, dermis,

hypodermis.

 the superficial region is the epithelial tissue, is

the epidermis.

 Deep to the epidermis, is the dermis, a fibrous

connective tissue.

 Deep to the skin lies a fatty layer called the

hypodermis [composed of loose areolar
connective & adipose tissue]
 EPIDERMIS LAYER 3

It is the outermost layer of skin.

• It is composed of keratinized stratified squamous epithelium.
• It consists of principal types of cells
A] Keratinocytes: About 90% of epidermal cells are keratinocytes
• Keratin is a tough, fibrous protein that helps to protect the skin and
underlying tissues from heat, microbes and chemicals
B] Melanocytes: About 8% of the epidermal cells are melanocytes and
produce pigment melanin. Melanin is the yellow red or brown black pigment
that contribute the skin color and absorb damaging UV light.
 DARMIS LAYER
4
Second deeper layer of the skin is dermis.
• It is composed of mainly connective tissue.
• Blood vessels, nerves, glands and hair follicle are embedded in the
dermis tissue.
• The dermis can be divided into:
A. Papillary region: the papillary region makes up to the 1/5th thickness
of total layer.
• It consist of areolar connective tissue containing fine elastic fibers.
B. Reticular region: the reticular region which is attached to the
subcutaneous layer, consists of dense irregular tissue containing
fibroblast, bundles of collagen and some elastic fibers.
5
 NAILS 6

 Thin plates of Keratinized Epidermal Cells That Cover the Distal Ends
of Fingers and Toes
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HAIR
 Thin fiber Compound of Dead Keratinized Cells –
 Vellus: ‘’peach fuzz’’
 Terminal
 THE MAJOR FUNCTIONS OF SKIN
>Perceiving touch, pressure, temperature, and pain via the
nerve endings.
>Protecting against mechanical, chemical, thermal, and
solar damage.
>Protecting against loss of water and electrolytes.
>Regulating body temperature.
>Repairing surface wounds through cellular replacement.
>Synthesizing vitamin D.
>Allowing identification through uniqueness of facial
contours, skin and hair color and fingerprint
 9

HEALTH COUNSELING
• Counsel patients to avoid unnecessary sun
exposure, and to use sunscreen with at least
SPF- 30 or 15.

• Teach the ABCDE screen for dysplastic

nevi/melanomas: Asymmetry, irregular Borders,
Color variation, Diameter ≥6 mm, and Evolution
and enlargement, symptoms, or morphology.
10
HEALTH HISTORY 11

>Before assessing the skin, ask the patient about

the presence of lesion, rashes, or bruises and
determined whether the alterations are linked to
heat, cold, and stress, exposure to toxic materials
or the sun, or new skin care products. Also
determined if there has been a recent change in
skin color or trauma to the skin.

>If a patient has been out in the sun, it is useful to

know if the patient wore sunscreen. If not, the
patient will require education on ways to safeguard
the skin. Also assess for history of allergies, use of
topical medications, and a family history of serious
skin disorders.
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PRESENT HEALTH CONCERN

< QUESTIONS >

Are you experiencing any current skin problems such as rashes, lesions, dryness,
oiliness, drainage, bruising, swelling, or increased pigmentation? What aggravates
the problem? What relieves it?
 Describe any birthmarks or moles you now have. Have any of them changed color,
size, or shape?
 Have you noticed any change in your ability to feel pain, pressure, light touch, or
temperature changes? Are you experiencing any pain, itching, tingling, or
numbness?
 Do you have trouble controlling body odor? How much do you perspire?
 Hair and Nails Have you had any hair loss or change in the condition of your hair?

 PAST HEALTH HISTORY 13

 Describe any previous problems with  Current problems may be a recurrence

skin, hair, or nails, including any of previous ones. Visible scars may be
treatment or surgery and its explained by previous problems.
effectiveness.

 Various types of allergens can

 Have you ever had any allergic skin
precipitate a variety of skin eruptions.
reactions to food, medications, plants, or
other environmental substances?

 Have you had a fever, nausea, vomiting,  Some skin rashes or lesions may be
gastrointestinal (GI), or respiratory related to viruses or bacteria.
problems?

 Depression often occurs in association

 Do you have a history of anxiety,
with dermatologic disease
depression, or any psychiatric problems?
Some skin and hair conditions can result
from hormonal imbalance.
 FAMILY HISTORY 14

 anyone in your family had a recent  Acne and atopic dermatitis tend to be
illness, rash, or other skin problem or familial. Viruses (e.g., chickenpox,
allergy? Describe. measles) can be highly contagious.
Some allergies may be identified from
family history.
 Has anyone in your family had skin
cancer?  A genetic component is associated
with skin cancer, especially malignant
melanoma.

 Do you have a family history of keloids?

 Ear piercing, if desired, should be
performed before age 11 if there is a
history to avoid keloid formation.
 Do you sunbathe? How much sun
exposure do you get? What type of
protection do you use?  Sun exposure can cause premature
aging of skin and increase the risk of
PREPARATION
(WIIPPPPE)

•Wash your hands

• You should wear gloves if the condition is weeping
or likely to be contagious
•Introduce yourself
•Identity of patient (confirm)
•Permission (consent and explain examination)
•Pain?
•Privacy
•Exposure

>Remember that some conditions require access to

certain areas (e.g. the elbows and scalp in psoriasis; the
soles in palmoplantar pustular psoriasis)
 16

EQUIPMENT'S
• Examination light
• Penlight
• Mirror for client's self-examination of skin
• Magnifying glass
• Centimeter ruler
• Gloves
• Wood's light
•Examination gown or drape
• Braden Scale for Predicting Pressure Sore Risk
• Pressure Ulcer Scale for Healing (PUSH) tool to
measure pressure ulcer healing
 SKIN EXAMINATION
17
>EXAMINE THE ENTIRE SKIN SURFACE UNDER GOOD LIGHTING.
>INSPECT AND PALPATE ANY GROWTHS.

NOTE:
<Examination Techniques> <Possible findings>

Color ;Cyanosis, jaundice, carotenemia,

;Changes in melanin.
• Moisture ;Dry, oily,
• Temperature ;Cool, warm
• Texture Smooth ;Smooth, rough
• Mobility-ease with which a fold of skin ;Decreased if edema
can be moved
• Turgor-speed with which the fold returns
;Decreased if dehydration
into place
 18
*INSPECTING THE PALMS IS AN OPPORTUNITY TO ASSESS
OVERALL COLORATION
 19
>ASSESSING TEMPERATURE & >PALPATING TO ASSESS SKIN
.MOISTURE TURGOR
AND MOBILITY.
 COLOR CHANGES IN THE SKIN 20

Color/Mechanism
selected causes

 Brown: Increased melanin (greater

 Sun exposure, Pregnancy (melasma)
than a person's genetic normal)  Addison's disease

 Blue: (cyanosis): increased  Anxiety or cold environment Heart or

deoxyhemoglobin from hypoxia: lung disease

• Peripheral
•Central (arterial)
•Abnormal hemoglobin.  Methemoglobinemia
 Red: Increased visibility of oxyhemoglobin Sulfhemoglobinemia
from:
•Dilated superficial blood vessels or increased  Fever, blushing, alcohol intake, local
blood flow in skin inflammation
 21
COLOR/MECHANISM SELECTED CAUSES

 Yellow:
 Liver disease, hemolysis of red blood cells
 Increased bilirubin of jaundice (sclera
 Increased carotene intake from yellow
looks yellow) Carotenemia (sclera does
fruits and vegetables
not look yellow)

 Pale:
 Albinism, vitiligo, tinea versicolor
 Decreased melanin Decreased visibility
of oxyhemoglobin from:
• Decreased blood flow to skin  Syncope or shock
• Decreased amount of oxyhemoglobin  Anemia
< Edema (may mask skin pigments)  Nephrotic syndrome
 22

tinea
Sulfhemoglobinem jaundice
versicolor
ia
Methemoglobine
mia
Albinism,
vertiligo
23
24
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 NAILS
26

 Inspect and palpate the fingernails and toenails

 Color Cyanosis, pallor

 Shape Clubbing
 Any lesions Paronychia,
onycholysis

 To assess capillary refill: press down on one of the patient’s nails until it
pales.

 Release the nail and observe for the pink color to return.

 the normal colour should return in less than 3 seconds.

 27
FINDINGS IN OR NEAR THE NAILS
 Clubbing
• Dorsal phalanx rounded and bulbous; convexity of nail plate increased. Angle between
plate and proximal nail fold increased to 180° or more. Proximal nail folds feel spongy.
Many causes, including chronic hypoxia and lung cancer.
 paronychia
 Inflammation of proximal and lateral nail folds, acute or chronic.
 Folds red, swollen, may be tender.
• Anonychia: complete absence of nails
• Platunychia: flatting nails

paronychia
 28

 Onycholysis
• Painless separation of nail plate from nail bed, starting distally.
Many causes

• Terry’s Nails
• Whitish with a distal band of reddish brown.
 Seen in aging and some chronic diseases.
Terry’s nails

Onycholysi Leukonychia
 Leukonychia
s
• White spots caused by trauma.
• They grow out with nail
• Transverse White Lines 29

• Transverse white bands appearing in the nail plate are often

caused by trauma to the more proximal matrix in the area of the
proximal nail fold; however, some bands, such as Mees lines,
Muehrcke lines are associated with systemic disease.

• Splinter hemorrhages: are tiny blood clots that tend to run

vertically under the nails. In certain conditions (in particular,
infective endocarditis), clots can migrate from the affected heart
valve and find their way into various parts of the body.

Splinter Transverse white

 30
HAIR
 Inspect and palpate the hair.
 Note:

• Quantity Thin, thick

• Distribution Patchy or total
alopecia
• Texture Fine, coarse

• Alopecia Areata: Clearly demarcated round or oval patches of hair loss, usually
affecting young adults and children. There is no visible scaling or inflammation.
• Trichotillomania Hair loss from pulling, plucking, or twisting hair. Hair 31
shafts are broken and of varying lengths. More common in children, often in
settings of family or psychosocial stress.

• Tinea Capitis [“Ringworm”] Round scaling patches of alopecia. Hairs

are broken off close to the surface of the scalp. Usually caused by fungal
infection from Trichophyton tonsurans from humans, microsporum canis from
dogs or cats. Mimics seborrheic dermatitis.
Tinea Trichotillomania
Capitis hair
Be kind, for everyone you meet,
is fighting a hard
battle………

THANK
YOU