by Alberto J. Muniagurria and Eduardo Baravalle
Examination of the skin is done through inspection and palpation. The skin is studied in an integral way or together with the systematic examination of each region of the body. To examine it, it is necessary to undress the patient in an environment of adequate temperature, especially in the case of children or the elderly, in whom extreme temperatures cause discomfort; the light must be appropriate, and sometimes it is necessary to use a magnifying glass. The light required for the skin exam is fluorescent light, because it is diffuse and bright.
In the skin , the color, temperature, humidity, texture or turgor, mobility and thickness will be described.
The color of the skin shows great variability between normal individuals. These variations are related to the amount of oxygenated hemoglobin and to the flow of circulation, which will give the pink hue; with the amount of melanic pigment, which gives the brown hue; and with the usual color of collagen and elastic fibers, which gives the yellowish hue.
Age produces variations in the color of the skin. The child has fine, well-vascularized skin, which allows easy observation of vasoconstriction and vasodilation changes. In the first twenty-four hours of life, the newborn presents an erythematous color that is compared to the color of boiled lobster. The vasomotor changes in young children, produced by temperature, generate a mottling that is known as marbled skin. An interesting phenomenon is described in the newborn, where one half body is red and the other pale, and the cause of which is unknown. Physiological jaundice is common in the first days of life.
Race and nationality have a significant influence on skin coloration; Nordics are usually white, Africans black, and Orientals yellowish. Likewise, it is important to consider the degree of sun exposure and the subject's work activity to assess the normal coloration of the skin.
The temperature , under normal conditions, should be the same throughout the skin. It can be increased after exercise, due to the greater circulatory contribution.
The moisture depends on the activity of the sweat glands; the sebaceous glands give it normal lubrication. Anxiety in front of the medical exam can cause increased sweating.
Age influences its texture and turgor. In the young child, to assess its hydration and the amount of subcutaneous tissue, the observer should take the skin between the index finger and the thumb. In this way its consistency is evaluated. Mobility and thickness vary according to the region examined, the state of hydration, the amount of subcutaneous cellular tissue and with age. In the elderly, the skin becomes paler due to the loss of elastic fibers, loses turgor and becomes cold and shiny.
Hair or hair. The examination of the hair is done by inspection and palpation. It must be described in terms of its length, color, shine, location, texture, brittleness and the ease with which it can be removed. Their distribution varies according to age, sex, habits, and race. In a physical examination, the scalp, armpits, pubis, and limbs should be observed, while still examining the eyebrows and eyelashes, mustaches and beard.