Skin assessments can reveal many hidden physical, psychological and social issues that can reflect in the skin’s condition. This is why it is essential to gather background information such as the history of the skin condition, medical history, possible triggers from family history, social history, medications, allergies and their impact on the patient’s quality of life.
For nurses and allied health practitioners working in the local community, conducting skin assessments should be included when patients show concerns with skin lesions or moles. However, thorough skin assessments may not be practical in primary care settings as examinations should include inspecting all areas of the skin from head to toe, including the nails, scalp, hair and mucous membranes.
Medical assessment of pigmented lesions and skin cancer screening requires specialist training and diagnostic equipment that can only be offered in a clinical setting. This is why patients with these concerns should be referred to their GP.
Patients may be able to partly undress in primary care settings to show enough skin for a cursory skin assessment. Patient questioning should be used to cover areas of the body that cannot be physically examined.
Four principles of dermatological assessment
There are four basic principles of skin assessment that are used in primary care settings. These are:
- Inspect the skin.
- Describe what you see on the skin.
- Palpate the skin.
- Systemic check.
Before conducting a skin assessment, you need to gain patient consent. Ensuring the patient is warm and comfortable and is examined in privacy is also essential. Effective skin assessments need to be conducted in good natural light or high-quality artificial light that doesn’t change or distort the colour of the skin.
1: Inspect
Inspecting the skin is the first stage of skin assessment. Using general observation to determine the pattern of configuration or distribution of solitary or grouped lesions or expansive skin eruptions, such as rashes.
Determining skin conditions that are confluent, asymmetrical or unilateral, acral, extensor, flexural, follicular, dermatomal, koebernised, or seborrhoeic is also important during your initial skin assessment.
2: Describe
The second stage of skin assessment describes the individual lesion or lesions, also referred to as primary lesions. Describing conditions using Size, Colour, Associated secondary change and Morphology and margin (SCAM) is a valuable tool in skin assessment. Changes in any of these descriptions should be documented in the patient record, and the patient should be referred to their GP for diagnosis.
3: Palpate
Touching the skin is an essential part of skin assessment. Palpation of the skin eruptions or lesions will help give you additional information. Palpating the affected area will allow you to assess the texture of the skin surface, consistency, thickness, mobility, tenderness and temperature.
4: Systemic check
You should include a systematic check to investigate the patient’s medical history, allergies and medications being taken. Psychological and social aspects should be examined to see if underlying issues impact their skin condition.
Practitioner Development UK Ltd. offers a range of educational and training courses for medical professionals. We recommend the following course for nurse practitioners, primary care nurses and associated medical professionals that work in a primary-care setting.
AR94 Recognising and managing acute skin conditions in primary care: Online
This is a one-day online workshop with all course material, evaluations, and certificates provided. It is designed for healthcare practitioners that want to update their skills in assessing and managing patients with acute skin conditions.
Dermatological presentations can often challenge healthcare providers and allied health professionals in primary care settings. This practical workshop will give you more confidence in assessing skin conditions and determining the most effective treatment approach.
This course will help participants to:
- Be more confident in dealing with exacerbated chronic dermatological conditions.
- Develop dermatology assessment skills.
- Improve your knowledge base of dermatological treatments and best practice for their use.
- Increase your awareness of the most common acute skin conditions and their management.
- Increase your knowledge of differential diagnoses in dermatology.
- Understand when to refer to secondary care and how to make an appropriate referral.
