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246 PHYSICAL EXAMINATION
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UNIT 2
ASSESSMENT: TAKING THE CONSUMER’S HEALTH HISTORY
Assessment is the rst phase of the nursing process. It involves collecting subjective
information about the consumer’s health status in order to identify consumer
problem areas to focus on.
Subjective data is most frequently collected during a health history and serves as
the starting point for the health professional to base the depth of their assessment
on. The sections for the health history include:
> Consumer prole
> Chief complaint (explained systematically using variations of location, quality,
quantity, associated manifestations, aggravating factors, alleviating factors,
setting and timing. This is a variation on the OPQRST assessment mnemonic you
may use for other conditions such as pain assessment)
> Past health history (including medical history, surgical history, allergies,
medications, injuries and accidents, special needs and childhood illnesses)
> Family health history
Social history (including alcohol, tobacco and drug use, sexual practice, work
>
and home environment, hobbies and leisure activities, stress and culture).
HEALTH HISTORY
CONSUMER
PROFILE
The skin, hair and nails health history provides insight into the link between a consumer’s life/lifestyle and skin, hair and
nails information and pathology.
Diseases that are age-, sex- and race-specic for the skin, hair and nails are listed.
AGE
SEX SKIN Skin pathology is consistently more prevalent among males than
CULTURAL
BACKGROUND
SKIN > Fungal infections, diseases of sebaceous glands, such as acne
vulgaris (13–26 years)
> Lupus erythematosus, psoriasis, hyperpigmented macular lesions,
skin tags (acrochordon), dermatophyte infections (25–60 years)
> Basal cell carcinoma (BCC) (older adults)
> Melanoma (all ages)
HAIR > Male pattern alopecia (adolescence to young adulthood)
> Thinning, greying, loss of hair in axillary and pubic areas, excessive
facial hair (middle to old age)
females; dermatophyte infections, skin tumours, fungal infections,
and increased incidence of tumours related to occupational
hazards and hygiene; Kaposi’s sarcoma associated with
immunodeficiency conditions
HAIR > Female: female pattern alopecia, increased facial hair with ageing
> Male: alopecia, increased coarse nose and ear hair with ageing
DARK-SKINNED Keloid formation, dermatosis papulosa nigra, hyperpigmentation
and hypopigmentation, traumatic marginal alopecia, seborrhoeic
dermatitis, pseudofolliculitis barbae, acne keloidalis, granuloma
inguinale, Mongolian spots, albinism, hypopigmented sarcoidosis,
granulomatosis skin lesions
LIGHT-SKINNED Squamous and basal cell carcinoma, actinic keratosis, psoriasis
>>
INTEGUMENTARY 247
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>>
HEALTH HISTORY
CHIEF COMPLAINT Common chief complaints for the skin, hair and nails are dened, and information on the characteristics of each sign
and symptom is provided.
1. PRURITUS Cutaneous itching that may have a multitude of aetiologies
LOCATION Generalised or localised
QUALITY Supercial or deep sensation of itching, intensity of itching,
interference with sleep habits
CHAPTER 8
ASSOCIATED
MANIFESTATIONS
AGGRAVATING
FACTORS
ALLEVIATING
FACTORS
SETTING Work, home, school or recreational environment
TIMING Preprandial or postprandial, nocturnal, seasonal, during periods of
2. RASH A cutaneous eruption that may be localised or generalised
3. LESION A circumscribed pathological change in the tissues
LOCATION Location of where it started and spread, distribution over the body,
QUANTITY Grouping or arrangement: discrete, grouped, conuent, linear,
QUALITY Morphology: macule, patch, papule, plaque, nodule, cyst, wheal,
Rashes, lesions, oedema, angioedema, anaphylaxis, excoriation or
ulcers as the result of scratching, lichenication (thickening of the
skin), systemic disease
Exposure to chemicals, sunlight, plants, food, animals, stress,
climate, parasites, xerosis (dry skin), drug reaction, systemic disease
processes, contact dermatitis, types of clothing (frequently wool)
Dietary changes, medications, antihistamines, biofeedback, cool
baths, types of clothing (frequently cotton), increased skin hydration,
ultraviolet-band light therapy
stress, associated with menstrual cycle
percentage of body involved, following dermatomes
annular, polycyclic, generalised, zosteriform
vesicle, pustule, bulla, tumour, lichenication, crust, erosion, ssure,
ulcer, atrophy
ASSOCIATED
MANIFESTATIONS
AGGRAVATING
FACTORS
ALLEVIATING
FACTORS
SETTING Work, home, school or recreational environment
TIMING When it started, preprandial or postprandial, nocturnal, seasonal,
Oedema, angioedema, anaphylaxis, excoriation or ulcers as the
result of scratching, lichenication, systemic disease, allergies, fever,
induration
Exposure to chemicals, sunlight, plants, food, animals, stress, climate,
parasites, xerosis, drug reaction, systemic disease processes,
contact dermatitis, radiation, types of clothing (frequently wool)
Dietary changes, medications, antihistamines, biofeedback, cool
baths, types of clothing (frequently cotton), increased skin hydration,
ultraviolet-band light therapy, surgery
during periods of stress, associated with menstrual cycle
>>
248 PHYSICAL EXAMINATION
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HEALTH HISTORY
UNIT 2
PAST HEALTH
HISTORY
The various components of the past health history are linked to skin, hair and nails pathology and skin-, hair- and
nails-related information.
MEDICAL HISTORY
SKIN-SPECIFIC Allergies, eczema, atopic dermatitis, melanoma, albinism, vitiligo,
psoriasis, skin cancer, athlete’s foot, birthmarks, body piercing,
tattoos, urticaria
NON-SKINSPECIFIC
HAIR-SPECIFIC Allergies, alopecia, lice, bacterial or fungal infections of the scalp,
NON-HAIRSPECIFIC
NAIL-SPECIFIC Allergies, psoriasis, bacterial or fungal infections, trauma, brittle nails,
Renal disease, diabetes mellitus, lupus erythematosus, peripheral
vascular disease, idiopathic thrombocytopaenia purpura (ITP),
Rocky Mountain spotted fever, liver disease, hepatitis, collagen
diseases, cardiac dysfunction, sexually transmitted infections, Lyme
disease, arthritis, lymphoma, thyroid disease, pregnancy, Addison’s
disease, pernicious anaemia, HIV, cytomegalovirus, Epstein-Barr
virus, measles, mumps, rubella, coxsackievirus, adenovirus, drug
hypersensitivities, varicella, herpes zoster, herpes simplex, Kawasaki
disease, toxic shock syndrome, carcinoma, tuberculosis, viral
syndromes
brittle hair, rapid hair loss, trichotillomania, trauma, congenital
anomalies
Renal disease, diabetes mellitus, cardiac dysfunction, peripheral
vascular disease, thyroid disease, pregnancy, Addison’s disease, HIV,
anaemia, malnutrition, stress, chemotherapy, radiation therapy
nail biting, congenital anomalies
NON-NAILSPECIFIC
SURGICAL HISTORY Keloid and scar formation, plastic surgery for birthmarks, skin grafts, reconstructive surgery,
excision biopsy
ALLERGIES Medication, insect stings, foods, soaps, laundry detergent, chemicals, bres (wool), metals
(nickel), animal dander, pollens, grasses, cosmetics, signs/symptoms of rst manifestation of
allergic reaction
MEDICATIONS Reaction manifested in skin changes after use of prescription or over-the-counter drugs
COMMUNICABLE
DISEASES
INJURIES AND
ACCIDENTS
SPECIAL NEEDS Poor eyesight can lead to poor hygiene; frequent skin trauma prevents early detection and
BLOOD
TRANSFUSIONS
CHILDHOOD
ILLNESSES
Varicella, roseola, measles, scabies, bacterial or fungal infections, HIV
Sexually transmitted infections: syphilis, gonorrhoea, chancroid, genital warts (see Chapter 17
for further information)
Chemical inhalation, trauma, burns, toxin contamination
treatment of skin diseases; bedridden or wheelchair bound with possibility of pressure injury
and compromise of skin integrity
Skin eruptions, pruritus
Refer to section on communicable diseases in Chapter 3
Iron-deciency anaemia, chronic infection, malnutrition, Raynaud’s
disease, hypoxia, acute infections, syphilis
>>
INTEGUMENTARY 249
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HEALTH HISTORY
FAMILY HEALTH
HISTORY
SOCIAL HISTORY The components of the social history are linked to skin, hair and nail factors/pathology.
Skin, hair and nail diseases that are familial in nature are listed.
SKIN-SPECIFIC Allergies, eczema, melanoma, albinism, vitiligo, psoriasis, non-melanoma skin cancer
HAIR-SPECIFIC Allergies, alopecia, brittle hair, hair loss
NAIL-SPECIFIC Brittle nails
ALCOHOL USE Hepatotoxicity and subsequent skin manifestations that accompany liver failure, such as
jaundice and pruritus; skin bruising and trauma from falls and ataxia; telangiectasia of the
nose, neck and upper chest
TOBACCO USE Yellow discolouration of ngertips on smoking hand, leathery facial appearance
DRUG USE Skin manifestations from intravenous drug use, such as injection sites or tracks; these are
especially prevalent in the forearms, behind the knees, toe webs, nger webs, and under the
nails
SEXUAL PRACTICE Various sexually transmitted infections may manifest in the genital region; these are
discussed in Chapters17
TRAVEL HISTORY
WORK
ENVIRONMENT
> Tropical regions: fungal infections, contact dermatitis, tropical eczema, leishmaniasis
> Insect bites and stings: insects indigenous to certain climates, such as re ants, bees,
spiders, wasps
> High-altitude areas: light-sensitive eruptions and winter eczema
> Chemical: contact dermatitis, burns
> Sunlight: skin eruptions, increased incidence of basal or squamous cell carcinoma (SCC),
burns, wrinkles, senile freckles, lightened hair, excessive exposure to ultraviolet radiation
> Excessive exposure to water: drying and cracking of skin, pruritus, soft nails, damaged hair
shafts
> Insect bites: rashes, urticaria, oedema, angioedema, pruritus
> Operating heavy or sharp equipment: trauma, laceration
> Excessive exposure to wind and cold temperatures: ageing, drying and cracking of skin
> Pollution: contact dermatitis
> Tar and pitch: act as both photosensitiser and carcinogen
CHAPTER 8
HOME
ENVIRONMENT
HOBBIES AND
LEISURE ACTIVITIES
STRESS Skin eruptions such as eczema, urticaria, acne and psoriasis may have a psychological
ECONOMIC STATUS People of lower socioeconomic status may develop skin eruptions associated with poor
Chemicals used in cleaning can cause contact dermatitis; excessive exposure to water can
cause dry, cracked skin, soft nails and damaged hair shafts; excessive heat in the home can
dry skin and cause pruritus; infected kittens and puppies may lead to tinea capitis
Gardening with exposure to chemicals, sunlight, contact dermatitis (e.g. chrysanthemums,
primula, tomato plants, grevillea, English ivy, occasionally rhus trees; lantana or vegetables
such as parsnip or celery may cause photo-contact dermatitis) and insect bites; outdoor
summer sports or activities increase sun and insect-bite exposure; outdoor winter activities
increase frostbite and exposure; excessive exposure to chlorine and salt water damages hair;
the climate in northern Australia particularly as well as excessive use of tanning salons may
lead to skin carcinoma
component in some cases; body image disorder as a result of skin disease and hair loss
hygiene because of insufcient resources, infestations associated with overcrowding, and
infections associated with malnutrition
Scabies and impetigo are common in conditions where housing is crowded and nutrition
and socioeconomic status is poor – therefore common in Aboriginal and Torres Strait
Islander communities
250 PHYSICAL EXAMINATION
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UNIT 2
CLINICAL REASONING
Practice tip: Focusing health history – self-care behaviours and risk
Before undertaking the physical examination, the following specic questions will assist you
to identify self-behaviours and potential risk factors that may enable you to opportunistically
provide person-centred health education.
> Skin care habits:
• Do you use lotions, perfumes, cologne, cosmetics, soaps, oils, shaving cream,
after-shave lotion, electric or standard razor?
• What type of home remedies do you use for skin lesions and rashes?
• How often do you bathe or shower?
• Do you use a tanning bed or salon?
• What type of sun protection do you use?
• Have you ever had a reaction to jewellery that you wore?
• Do you wear hats, visors, gloves, long sleeves or pants, sunscreen when in the sun?
• How much time do you spend in the sun?
> Hair care habits:
• Do you use shampoo, conditioner, hair spray, setting products (e.g. mousse or gel)?
• Do you colour, dye or bleach your hair?
• What products do you use?
• Do you wear a wig or hairpiece?
• Do you have greying hair or hair loss?
• Do you use a hair dryer, heated curlers, hair straightener or curling iron?
• Do you tightly braid your hair?
> Nail care habits:
• Do you get manicures or pedicures?
• What type of nail care do you practise (trimming, clipping, use of polish, nail tips, acrylics)?
• Do you bite your nails?
• Do you suffer from nail splitting or discolouration?
PERSON-CENTRED HEALTH EDUCATION
When conducting a health assessment, opportunities for the provision of personcentred health education will arise. This is a signicant consideration in relation
to the assessment process for examination of the skin, hair and nails, due to their
associated personal identity aspects and lifestyle choices for preventative care. These
occasions are identied as individualised education and may generate further data
that can be added to the assessment. All education given should be documented so
that in the future, health professionals can assess the impact of previous information
provided to the consumer. (Refer to Chapter 1 for initiating health education.)
INDIVIDUALISED HEALTH EDUCATION INTERVENTIONS
Assessing the person for the following health-related activities can assist in identifying the need
for education about these factors. This information provides a bridge between health maintenance
activities and the function of skin, hair and nails.
Sleep Sleep disturbances caused by symptoms such as itching or burning
Diet Allergies to food can cause skin eruptions such as urticaria; diets high in fat and
cholesterol may be connected to the development of xanthelasmatous lesions; vitamin
deciencies result in skin, hair and nail changes; see Chapter 15 for further information
Exercise Increased risk for cutaneous trauma associated with contact sports and sun exposure with
outdoor sports and activities
Use of safety
devices
Sunblock/sunscreen with appropriate sun protection factor (SPF) to prevent UV exposure;
lotions and creams to prevent drying and cracking of skin; protective gloves when handling
harsh, irritating chemicals; use of protective clothing for environmental conditions
INTEGUMENTARY 251
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PLANNING FOR PHYSICAL EXAMINATION
The planning phase refers to evaluating subjective data to narrow the focus on
physical examination, determining what objective data needs to be gathered, and
considering the environment and equipment that will be required.
Objective data is collected during the physical examination of the consumer. It is:
> usually collected after subjective data
> information that is measured or observed by the clinician as opposed to being
reported by the consumer
> vital to the overall health assessment, to enable you to make clinical decisions that are
representative of the whole consumer subjective data to focus physical examination.
Before commencing the physical examination of the consumer’s integumentary
system (e.g. skin, hair, nails), consider what information the health history has provided.
Critical consideration, linked to knowledge of anatomy and physiology, should focus the
physical assessment so your examination will be more effective and efcient.
Environment
Assessment of the hair, skin and nails needs to be done in a suitable environment
that can provide privacy and a comfortable temperature, as you will need to be able
to completely undress the person to access all of his or her skin.
CHAPTER 8
Equipment
> Magnifying glass
> Good source of natural light
> Penlight
> Nonsterile gloves
> Small centimetre ruler
HEALTH EDUCATION
Reducing exposure to integumentary irritants
Workplace-related skin disease is a common and expensive issue in Australia and New
Zealand. It can impact people at any time of life, even if there is no history of allergies and
which could mostly be prevented (Skin Health Institute, 2022).
Allergic contact dermatitis is the leading workplace-related skin disease in Australia
and New Zealand, and hands are the most commonly affected body part. Many workplaces
will provide support for workers to help them reduce their exposure to these irritants with
products, procedures and guidelines. The following professions are most commonly affected:
> Hairdresser
> Food handler (bakers, caterers, cooks and confectioners)
> Health workers (especially nurses)
> Construction and industry workers
> Leather and shoe manufacturers
> Florists
> Gardeners
> Metal workers
To reduce exposure, follow these guidelines:
> In the workplace, always follow Occupational Safety and Health Administration and
employer’s safety guidelines.
> Follow the directions on the labels of all products; pay special attention to warning labels.
> If using a personal care product for the rst time, perform a patch test to evaluate for sensitivity.
> Use rubber gloves when handling toxins or caustic substances.
> Contact a poison control centre for treatment guidelines if exposed to toxic or caustic substances.
> Notify HAZMAT (hazardous materials) ofcials if a dangerous chemical or toxin exposure occurs.
252 PHYSICAL EXAMINATION
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UNIT 2
EXAMINATION IN BRIEF: SKIN, HAIR AND NAILS
IMPLEMENTATION: CONDUCTING THE
PHYSICAL EXAMINATION
Implementation of the physical examination requires you to consider your scope of
practice as well. In this section, depending on your context, you may be performing
foundation assessment with aspects of advanced assessment if you are practising in
a specialised area.
Examination of the skin
Inspection
> Colour
> Bleeding, ecchymosis and vascularity
> Lesions
Palpation
> Moisture
> Temperature
> Tenderness
> Texture
> Turgor
> Oedema
Examination of the hair
Inspection
> Colour
> Distribution
> Lesions
Palpation
> Texture
Examination of the nails
Inspection
> Colour
> Shape and conguration
Palpation
> Texture
General approach to examination of the skin
1. Ensure that the room is well lit. Daylight is the best source of light, especially
when determining skin colour. However, if daylight is unavailable, overhead
uorescent lights should be added.
2. Use a handheld magnifying glass to aid in inspection when simple visual
inspection is not adequate.
3. Explain to the consumer each step of the examination process prior to
initiating the assessment.
4. Ensure consumer privacy by providing drapes.
5. Ensure the comfort of the consumer by keeping the room at an appropriate
temperature.
6. Warm hands by washing them in warm water prior to the examination.
7. Gather equipment on a table prior to initiating the examination.
8. Ask the person to undress completely and put on a gown, leaving the back
untied.
9. Perform the examination in a cephalocaudal fashion.
10. For episodic illness, the skin examination is incorporated into the regional
physical examination.
Examination of the skin
In each area, observe for colour, bleeding, ecchymosis, vascularity, lesions, moisture,
temperature, texture, turgor and oedema.
Inspection
1. Facing the consumer, inspect the colour of the skin of the face, eyelids, ears,
E
nose, lips and mucous membranes.
2. Inspect the anterior and lateral aspects of the neck, then behind the ears.
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
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E
3. Inspect arms and dorsal and palmar surfaces of the hands. Pay special
attention to the webs between the ngers.
4. Have the consumer move to a supine position with arms placed over the
head.
5. Lower gown to uncover chest and breasts.
6. Inspect intramammary folds and ridges. Pendulous breasts may need to be
raised to complete this inspection.
7. Assess axillae, and then cover chest and breasts with gown.
8. Raise gown to uncover abdomen and anterior aspect of the lower
extremities; place a sheet over the genital area.
9. Inspect abdomen, anterior aspect of the lower extremities, dorsal and
plantar surfaces of the feet, and toe webs.
10. Don gloves and uncover genital area.
11. Inspect inguinal folds and genitalia.
12. Remove and discard gloves.
13. Have the consumer turn to a side-lying position on the examination table
so their back is facing you.
14. Inspect back and posterior neck and scalp. Specically look for naevi or
other lesions.
15. Inspect posterior aspect of the lower extremities.
16. Don nonsterile gloves and raise the gluteal cleft and inspect the gluteal folds
and perianal area; then remove and discard the gloves.
17. Cover the person and assist them back to a sitting position.
18. Wash hands.
CHAPTER 8
CLINICAL REASONING
Practice tip: Tattoos and body piercings
It is important to inspect the skin and note the presence and location of tattoos and body
piercings (
skin disorders. Body piercing sites should be assessed for signs of infection (e.g. erythema,
purulent discharge, increased skin temperature). Remember to assess all body areas. The
ears, umbilicus, eyebrows, lips, nares, tongue, vagina and scrotum are often pierced. Ask
the patient if they change or remove piercings, or have any concerns with their piercings.
Document the location of all tattoos and body piercings in relation to anatomical location.
MEDICAL IMAGES/SCOTT CAMA ZINE
Figure 8.4). Some consumers react to the ink in the tattoo and develop various
FIGURE 8.4 Tattoos and body piercings
ALAMY STOCK PHOTO/NICK YOUNG
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
254 PHYSICAL EXAMINATION
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UNIT 2
Colour
E
Assess for colouration.
N
Normally, the skin is a uniform whitish-pink or brown colour, depending on the
person’s race. Exposure to sunlight results in increased pigmentation of
sun-exposed areas. Dark-skinned persons may normally have a freckling of the
gums, tongue borders, and lining of the cheeks; the gingiva may appear blue or
variegated in colour.
The appearance of cyanotic (dusky blue) ngers, lips or mucous membranes is
A
abnormal in both light- and dark-skinned individuals. In light-skinned
individuals, the skin has a bluish tint. The earlobes, lower eyelids, lips, oral
mucosa, nail beds, and palmar and plantar surfaces may be especially cyanotic.
Dark-skinned individuals have an ashen-grey to pale tint, and the lips and
tongue are good indicators of cyanosis.
Cyanosis occurs when there is greater than 0.05g/mL of deoxygenated
P
haemoglobin in the blood. In order for cyanosis to be an accurate indicator of
arterial oxygen (PaO
normal haemoglobin and
example, a consumer with
can be cyanotic but have adequate oxygenation. The problem lies in the fact
that the consumer has too many red blood cells rather than too little oxygen.
Conversely, a consumer with anaemia (reduced number of red blood cells) can
be hypoxaemic but not cyanotic. In this case, the consumer has too little
haemoglobin. Central cyanosis is secondary to marked heart and lung disease;
peripheral cyanosis can be secondary to systemic disease, or vasoconstriction
stimulated by cold temperatures or anxiety.
A
The appearance of
skin, sclera, mucous membranes, ngernails, and palmar or plantar surfaces in
the light-skinned individual is abnormal (
individuals may appear as yellow staining in the sclera, hard palate, and palmar
or plantar surfaces.
Jaundice is caused by an increased serum bilirubin level of greater than
P
0.02 mg/mL associated with liver disease or haemolytic disease. Severe burns
and sepsis also can produce jaundice.
A
A yellow discolouration of the palmar and digital creases is abnormal.
P
Xanthoma striata palmaris is caused by hyperlipidaemia.
A
A greyish cast to the skin is abnormal.
A greyish cast is seen in consumers with renal concerns and is associated with
P
chronic anaemia along with retained urochrome pigments. Slight jaundice may
also be found in the consumer with renal disease.
A
Sustained bright red or pink colouration in light-skinned individuals is
abnormal. Dark-skinned individuals may have no underlying change in
colouration. Palpation may be used to ascertain signs of warmth, swelling or
induration.
Hyperaemia occurs because of dilated supercial blood vessels, increased blood
P
ow, febrile states, local inammatory condition or excessive alcohol intake.
A
A bright red to ruddy, sustained appearance that is evident on the integument,
mucous membranes and palmar or plantar surfaces is abnormal in both
light- and dark-skinned individuals.
Polycythaemia, as noted earlier, is an increased number of red blood cells and
P
results in this ruddy appearance.
A
A dusky rubor of the extremities when in a dependent position, which can be
associated with tissue necrosis, is abnormal.
), two conditions must be met: the consumer must have
2
haematocrit as well as normal perfusion. For
polycythaemia (elevated number of red blood cells)
jaundice (yellow-green to orange cast or colouration) of
Figure 8.5A). Jaundice in dark-skinned
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
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P
Venous stasis results from venule engorgement and diminished blood ow,
which occurs in congestive heart failure and
A
A pale cast to the skin that may be most evident in the face, mucous
atherosclerosis.
membranes, lips and nail beds is abnormal in light-skinned individuals. A
yellow-brown to ashen-grey cast to the skin along with pale or grey lips, mucous
membranes and nail beds is abnormal in dark-skinned individuals.
P
Pallor is due to decreased visibility of the normal oxyhaemoglobin. This can
occur when the person has decreased blood ow in the supercial vessels, as in
shock or
syncope, or when there is a decreased amount of serum
oxyhaemoglobin, as in anaemia. Localised pallor may be secondary to arterial
insufciency.
A
A brown cast to parts of the skin can be generalised or discrete.
P
A brown colouration occurs when there is a deposition of melanin, which can be
caused by genetic predisposition, pregnancy, Addison’s disease (deciency in
cortisol leading to enhanced melanin production), café au lait spots (
Figure 8.5B)
and sunlight.
P
Acanthosis nigricans is a condition in which the skin becomes brownish and
thicker, almost leathery in appearance (
Figure 8.5C). This usually occurs in the
axillae, on the exoral surfaces of the groin and neck, and around the umbilicus.
Acanthosis nigricans occurs in obesity, diabetes mellitus, and with medications
such as steroids.
A
A white cast to the skin as evidenced by generalised whiteness, including of the
hair and eyebrows, is abnormal (see
P
This lack of colouration is caused by
Figure 8.5D).
albinism, a congenital inability to form
melanin.
P
Vitiligo is a condition marked by patchy, symmetrical areas of white on the
skin and is abnormal (see
P
This condition can be caused by an acquired loss of melanin. Trauma can also
Figure 8.5E).
lead to hypopigmentation, especially in dark-skinned individuals.
A
An erythematous, conuent eruption in a buttery-like distribution over the face
is abnormal.
P
Systemic lupus erythematosus, a connective tissue disorder, is the most likely
aetiology.
CHAPTER 8
A. Jaundice. Note the yellowing of the skin as well as the eyes
(in fair-skinned people). In some darker-skinned people, often
this may only be apparent in the conjunctiva of the eyes
FIGURE 8.5 Skin colour abnormalities
E
ExaminationNNormal ndingsAAbnormal ndingsPPathophysiology
SHUTTERSTOCK.COM/ZAY NYI NYI
B. Café au lait spots
ENCE PH OTO LIBR ARY/DR P MA RAZ ZI
SCI
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