What does it mean to get a full skin assessment from a dermatologist?
Key learning points:
– A holistic skin assessment should include physical examination and individual assessment of psychological and social effects
– The language of dermatology is terminology that should be used when describing skin eruptions or lesions
– Touch is a critical component of skin assessment
Skin assessment should always be included in a holistic patient assessment. Primary care nurses observe and assess their patient’s skin on a daily basis. Patients will often ask primary care nurses about a rash or spot when they have concerns about their skin or have observed that their skin has changed. In dermatology, the word rash would describe a skin eruption and the word spot refers to a skin lesion. Primary care nurses should document any skin changes or concerns about new or existing skin lesions, and it is useful for them to know terminology used to describe skin changes.
This article provides an introduction to skin assessment and the language of dermatology, with the overall aim of helping primary care nurses to understand how to assess and describe what they observe on their patient’s skin.
A skin assessment should consider the physical, psychological and social aspects of a skin condition or concern. A skin assessment should include the presenting concern/compliant with the skin, history of the presenting concern/compliant, past medical history, family history, social history, medicines (including topical treatment) and allergies and impact on quality of life.1 A nurse working in the community should conduct a skin assessment when the patient presents with a skin eruption on one or several parts of their body. Ideally, a skin assessment should also be conducted for patients concerned with skin lesions or moles, but this may not be practical in a primary care setting. In addition assessing pigmented lesions and screening for skin cancer requires specialist training, so patients should be referred to a GP.
A helpful acronym to remember the specific questions to ask patients when taking a skin history is ‘OLD CARTS’, which gives a systematic approach to questioning in a skin assessment, this includes onset, location, duration, character, aggravating factors, relieving factors, timing and severity.2
Skin examination is essential to inspect all areas of the skin from head to toe (including the nails, scalp, hair and mucous membranes).
At a dermatology appointment in secondary care, a full skin assessment involves the need for the patient to undress, so privacy and dignity is essential. However, chaperones will be required to examine genital areas. In primary care, this may not be practical as the patient may not be able to fully undress. In primary care, patients can partly undress and show areas of skin and questioning may be required for areas of the body that cannot be examined.
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