History and physical

examination of the skin, hair

and nail
Ns. Ahmad Hasyim W, M.Kep, MN, CWCC

Aim

Objectives
History taking

After completing this session

students are expected to
understand the principles of
assessment of the skin, hair
and nail

Skin assessment
Hair assessment
Nail assessment

The Assessment framework

Problem
focused
assessment
Detailed &
comprehens
ive
assessment

Sufficient for most common skin disorders

If the patient has systemic complaints, or if

diseases such as lupus erythematous or vasculitis
are suspected

ANAMNESIS

1st ask about: chief complaint and the PQRST

Initial and subsequent morphology and location(s) of lesions
Symptoms (eg, itch, pain, tenderness, burning)
Date of onset and duration
Medications (including over-the-counter products) used for
treatment and response to treatment
History of previous similar problem

ANAMNESIS
Family history
Ask about adverse reaction to medications, foods, and
pollens allergy
In cancer-suspects:
What changes have occurred the size and appearance of the
lesion?

Is there a history of spontaneous or trauma-induced bleeding in

the lesion?

Physical examination + sign and

symptom identification

Assessin
g Skin
Color

Assessin
g Rash

Assessin
g Skin
Lesions

Assessin
g the
Nails

Assessin
g the
Hair

Assessing Skin Color

Pallor

Anemia, Shock, Local arterial

insufficiency

Centralchronic heart and lung diseases

Cyanosiscause arterial desaturation
Peripheralexposure to cold, anxiety

JaundiceIncreased serum bilirubin, Uremia

ErythemaHyperemia, Polycythemia, Venous stasis

Assessing Rash
Manifested by: reddish tone, changes in skin texture, the
rash may be palpable, increased local temperature

Assessing Skin Lesions

NODULE, TUMOR

VESICLE, BULLA
PUSTULE

Pus-filled vesicle or bulla Acne, impetigo, furuncles,

carbuncles

Assessing Skin Lesions

ULCER
FISSURE
KELOID

NODULE, TUMOR

VESICLE, BULLA

PUSTULE
ULCER
FISSURE

ULCER

KELOID

Assessing the Nails

ASSESS FOR:
Color change
Clubbing finger
Odor
exudate

Assessing the Hair

Color and Texture
Distribution
Hair Loss

Gerontologic consideration
Loss of the subcutaneous tissue substances of elastin, collagen, and fat
Epidermis and dermis thin and flatten, causing wrinkles
Hair growth gradually diminishes, especially over the lower legs and
dorsum of the feet

LABORATORY TESTS IN
INTEGUMENT SYSTEM
Ns. Ahmad Hasyim W, M.Kep, MN, CWCC

COMMON LAB TESTS

Wound culture
Skin Biopsy
Skin Scrapings

Wound Infection
Growth of an organism in a wound
with associated tissue reaction
Infection delays wound healing
Identify patients at risk i.e those with
predisposing conditions

Cara Pengambilan Kultur

Siapkan alat pengambilan kultur dan balutan

Cuci tangan
Gunakan sarung tangan bersih
Buka balutan luka lama
Cuci luka dengan larutan normal saline JANGAN antiseptik
Keringkan dengan kasa steril
Tunggu sampai eksudat keluar

Lakukan pengambilan sampel kultur dengan

mengusap zig zag sebanyak 10 kali usapan yang
mewakili seluruh area luka

Sampel dikirim ke lab, jika tertunda pengiriman harus

disimpan dalam almari es / suhu dingin

Cara Pengambilan
Kultur

Skin Biopsy
Performed to obtain tissue for microscopic examination
Specific identification of cell type
Biopsies are performed on skin nodules, plaques, blisters,
and
other lesions to rule out malignancy and to establish an
exact diagnosis

Skin Scrapings
Tissue samples are scraped
from suspected fungal
lesions with a scalpel blade
The scraped material is
transferred to a glass slide,
covered with a coverslip, and
examined microscopically
Tinea Versicolor Infection

Herpes Simplex

Extra: Skin Test for allergy

Intradermal injection of several
different solutions applied at
separate sites

THANK YOU