Assessment of the skin, nails and hair includes inspection and palpation. As you assess the skin, hair and nails keep the patient must be adequately exposed and draped. The skills of inspection and palpation can be combined to improve the flow and organization of the assessment.

Inspection

1. Assess color by inspecting the skin, hair, and nails for erythema, pallor, cyanosis, and jaundice. Erythema is excessive redness that may be present on the skin surface or a mucous membrane. Pallor (paleness) can be assessed by looking at the fingernails, lips, mucous membranes, palms and soles in dark skinned people. To assess cyanosis (a purplish hue) look at the lips, oral mucosa, tongue, nails, hands and feet. Jaundice is a yellowish discoloration. Using a penlight look at the sclerae, conjunctivae, lips, hard palate, tongue, and skin in general.
2. Look for areas of hypo or hyperpigmentation on upper and lower extremities, the trunk and face. Inspect for bruising and rashes,
3. Assess the scalp and hair, look at the distribution, quality, quantity and texture. Part the hair into sections or strips to thoroughly assess the scalp for lesions and potential infestations.
4. Examine the nails and nailbeds, noting color, shape and presence of lesions. Look at the fingers and toes of both hands and feet, noting the condition of the nails on all four limbs.
5. Note the presence and characteristics of any skin, hair or scalp lesions, note their size (in millimeters), color, location, distribution, pattern, shape and type. Examine the entire trunk and extremities including the palms of the hands and soles of the feet.
6. Identify any nevi and apply the ABCDE method to screen for melanoma: Asymmetry, Borders, Color, Diameter, Evolution.

Palpation

1. Note skin temperature by palpating the upper and lower extremities, (anterior and posterior) including the fingers and toes, with the back of a hand.
2. Feel skin moisture and texture by palpating the upper and lower extremities, (anterior and posterior) including the fingers and toes.
3. Assess skin turgor (hydration) by pinching the skin over the dorsal hand.
4. Palpate hair texture in 2 separate areas.
5. Palpate fingernails and toenails noting irregularities in texture, strength, and thickness.

Video

Examination Checklists

Documenting Assessment Findings

Skin is warm, dry, clean, and intact. The colour is ethnically appropriate. Skin turgor is normal, and the skin is well hydrated. Hair distribution on the scalp is complete, with normal hair distribution on the arms and legs. Nails are neatly trimmed with a 160-degree angle at the base. Capillary refill time is brisk at 2-3 seconds. The patient denies skin discomforts such as pruritis, dryness, or chafing. There were no lesions observed.

Table 2.0 SCALDA mnemonic