Integumentary System
Lesson 2: Physical Assessment of the Integumentary System
2-3
2-3. ELEMENTS TO CONSIDER WHILE DOING AN INSPECTION
a. General. Consider the skin as a separate organ system; that is, a group of tissues that perform several specific functions. The skin is an organ of relatively unique size. One of its unique features is the large surface area. The size of an adult male skin is roughly equal to a 6 by 3 foot sheet. Skin has many functions. It serves as a sensory organ, as an organ of metabolism having synthesizing, excretory, and absorptive functions; as a protective barrier against the external environment; and as an important factor in temperature regulation. A clinical examination of the skin is an assessment of all these special functions. Additionally, the skin works with internal organs and often reflects diseases in internal body organs. Therefore, the skin is not only an organ with its own special patterns, but it is also a mirror reflecting the condition of the interior of the body.
b. The Examination. The examination should be conducted in a well-lighted room. If possible, use natural daylight or a daylight type of artificial light. Begin by a low power scan of the patient's skin as a whole--skin surface, nails, and mucous membranes. Assess color, the degree of moisture, the turgor (normal tension in a cell), and the texture of the skin. Remember that inspection of skin involves looking for changes on the skin surface and changes immediately beneath the surface.
c. Ultraviolet Light Inspection. Sometimes skin conditions are best seen under ultraviolet light.
(1) Wood's lamp (black light). This light, developed by R. W. Wood, a United States (US) physicist, is used to diagnose fungal infections. The light filter, made of glass containing nickel oxide, transmits only ultraviolet rays. When placed under this lamp, the fungal lesions on skin with the disease tinea capitis, for example, fluoresce. This ultraviolet light, a black light, allows the doctor to see the skin lesions clearly.
(2) Tinea versicolor. This superficial fungal infection is characterized by scaling, annular red, white, or brown patches. When these patches are viewed under the Wood's lamp, the skin lesions are a gold color. These eruptions are not dangerous but are not pleasant to look at. A physician can diagnose this disease by looking at the lesions, putting potassium hydroxide on the lesions, and examining the lesions under a Wood's light.
