Skin

Component

Question

General

Describe your skin.

Texture

How does it feel? Dry or moist?

Are there any areas where the texture of your skin is different? For example: at the elbows, the knees, the nape of the neck, upper back, and over the buttocks

How does the skin feel over these areas? Drier? Scaling? Itchy?

How long have these changes been occurring over the different skin areas?

Describe the color of your skin.

Has the color of your skin changed at all over the last few months?

If the color has changed, what is the change?

Name the areas where the change in skin color has occurred.

Rashes

Do you have any rashes on your skin?

Where are they located?

How long have you had the rash?

Explain how the rash appears.

Does the rash have a pattern?

Are the areas round?

Do the areas “run together” as one large patch?

Are the areas small and separated by large patches of skin?

Are the areas grouped together, for example, on the front of the lower leg or the outer area of the upper thigh?

Does the rash form a straight line?

Does the rash include blisters?

Is there any fluid coming out of the rash areas?

Does the rash itch?

What have you been using to help with the rash? Does it help?

Have you talked with your doctor or health care provider about the rash?

Moisture

In your own words, describe how much you sweat.

In what areas does this sweating occur the most? For example, under the armpits, the neck, around the face, the groin, behind the knees.

Has the amount that you sweat changed over the last weeks or months?

Is there an odor associated with the sweat?

Have you noticed if the sweating is more or less during a particular time of the day or night?

Do you have a history of skin rashes or allergies?

Integrity

Do you have any areas where the skin is eroded, scaled, peeling, or blistered?

Are you experiencing any drainage from skin areas?

Do you have any sores, ulcers, or wounds on your skin? Where are these areas located?

Describe what the sore/ulcer/wound looks like.

Describe what the skin around the sore/ulcer/wound looks like.

Is the skin around the sore/ulcer/wound warm/hot to the touch? Red or pale in color?

What have you been doing to treat the sore/ulcer/wound?

Have you talked with your doctor or health care provider about the sore/ulcer/wound?

Is the treatment improving the sore/ulcer/wound?

Do you have any skin tags or moles?

Where are these located?

Are there any body areas that have more skin tags or moles?

Have you noticed any changes to these areas?

Have you had these areas examined by a doctor, health care provider, or dermatologist?

Have you had any skin tags/moles treated?

Have you ever been diagnosed or treated for skin cancer?

If so, what was the location on your body that the skin tags/moles were treated?

Are you taking or prescribed any medication to treat a particular skin problem?

  If so, what is the skin problem?

  What is the name of the medication?

  How often do you apply it?

  How long are you supposed to use it?

  What follow-up has your doctor or health care provider prescribed for the skin problem?

Do you have any lumps?

Where are these located?

If lumps are present, how do they feel?

  Hard? Soft?

  Can they be moved under the skin or are they firmly attached?

  What is the color of the skin over the lump?

  Is the lump itchy?

  Red or warm to the touch?

Have you ever had these before? If so, how were they treated?

Do you have any bumps or swollen areas on the skin?

Where are these located?

Do you know how they developed? For example, did you bump the area against a piece of furniture?

Describe the color of the skin over the bump.

Does the skin feel hot or cool to the touch?

Have you ever had these before? If so, how were they treated?

Do you have any bruises on the skin?

Where are these located?

Do they have a pattern? Are they clustered together or scattered?

Are they tender to the touch?

Describe the color of the bruises.

Have you ever had these before? If so, how were they treated?

Do you have any tender or painful areas on the skin?

Where are these located?

How long have these areas been tender or painful?

Have you seen your doctor or health care professional about the lumps, bumps, bruises, or tender/painful areas?

  If so, what treatment was prescribed?

  Has the treatment improved the area?

  Made the area worse?

  No noticeable change in the area?

Past history

Have you ever been diagnosed with a problem that specifically affects your skin?

If so, how was the skin problem treated?

When was the last time that you experienced the skin problem?

Does it reoccur at specific times of the year or under specific conditions?

Have you ever been diagnosed with a skin allergy?

Have you had any health problems that affected your skin in any way?

Have you ever taken a medication that caused a skin problem?

Do you remember the name of the medication?

What was the skin problem?

What was done to treat the skin problem at that time?

Has that skin problem reoccurred?

On a scale of 1 to 10 with 1 being worse and 10 being the best, how would you rate your overall skin health at this time?

Bathing, cleansing, basic care

How often do you cleanse the skin? (shower, bathtub, sponge bath)

What products are used for skin cleansing?

Do you apply anything on the skin after cleansing it?

How often do you apply something on the skin through the course of a day? Once, twice, several times?

Sun (UV) exposure

Do you routinely expose your skin to the sun?

How often do you expose your skin to the sun?

At what times during the day do you expose your skin to the sun?

Have you ever used a tanning bed?

If so, how long was each session?

How many times did you use the tanning bed?

Have you ever had a sunburn?

What did you use to treat the sunburn?

Do you routinely apply a sunblock when exposing the skin to the sun?

What sun protection factor (SPF) do you routinely use?

Have you ever seen a dermatologist for a change in the skin after being exposed to the sun?

Have you ever been treated for a sun-related skin change? If so, what was the change and the treatment?

Have you ever been counseled to avoid exposing your skin to direct sunlight unprotected with a sunblock?

Body Piercings

Do you have any body piercings?

Where are these piercings located?

Are you experiencing any swelling, redness, or pain at the areas of the piercings?

Body art

Do you have any tattoos?

When were the tattoos placed?

Where are the tattoos located?

Have you experienced any swelling, redness, or pain at the areas of the tattoos?

Has the image tattooed changed in any way? Become distorted from swelling?

Hair

Head

What color is your hair?

Has your hair changed in color over the last weeks or months?

How often do you wash your hair?

How would you describe your hair? Thick, thin, dry, oily, curly, wavy, straight?

What products do you use on your hair routinely?

Have you noticed any change in the amount of hair you have on your head?

When did this change first occur?

Have you discussed this change in hair on your head with your doctor or health care professional?

Are you doing anything to address the change in hair on your head?

Are you using any over-the-counter products to increase the amount of hair you have on your head?

Do you have flakes or dandruff?

Do you use any products to address the flakes or dandruff?

Body

Have you noticed any changes in the amount of body hair?

For men: Have you noticed any changes in the amount of facial hair? Do you have any swollen hair follicles on your face that are more noticeable after shaving?

For women: Have you noticed any changes in the amount of hair under your arms or on your legs? Have you experienced any new facial hair growth?

For both men and women: Have you discussed this change in body hair with your doctor or health care professional?

Nails

Fingers

Describe the condition of your fingernails.

Are your fingernails short or long?

How do you perform fingernail care? Do you do it yourself or do you go to a nail salon?

Do you have artificial nails or gels applied to your fingernails?

Have you had any infections around the nails?

Have you had any swellings or pain near the cuticle of the nails?

Describe the shape of your nails.

Place both of your index fingers together, nail to nail. Can you see a diamond shape of light between the nail surfaces?

Are your nails straight or curved?

If they are curved, are the nails growing over the tips of your fingers?

Toes

Describe the condition of your toenails.

Are your toenails long or short?

How do you perform toenail care? Do you go to a podiatrist? Or a salon for routine pedicures?

What is the color of your toenails?

Do you routinely have polish or gel applied to your toenails?

Are any of your toenails crumbling or thickened?

Do you have any areas of redness/soreness/pain around the toenail or cuticle?

Identified Problem

Focused Question

Excessive sweating during the night

Have you been experiencing a cough or other respiratory health problem?

Have you ever been tested for tuberculosis?

Have you been losing weight for no apparent reason such as a diet change?

Itchy skin (appropriate for contact/allergic dermatitis or general pruritus)

How long has your skin been itchy?

What helps the itchiness?

Where does the itchiness occur?

Are there any red areas that are itchy or is the skin overall itchy?

Have you changed the type of soap, laundry detergent, shampoo, lotion, perfume, or shaving cream lately?

Is the itchiness more pronounced during a specific time of day?

Does the itchiness prevent you from sleeping at night?

What have you done to reduce the itching?

Have you recently started taking any new medications?

Have you talked with your (doctor, health care provider) about the itchiness?

Have you ever been tested for allergies?

Draining wound

When did the wound first appear?

Describe the size and color of the wound.

Describe the drainage from the wound.

What have you applied to the wound?

What does the skin around the wound look like? Is it red or pale?

What does the skin around the wound feel like? Is it cold or hot?

Rate the amount of pain you are having from the wound on a scale of 1 to 10 with 1 being minimal or no pain to 10 being the worst possible pain.

Have you seen your doctor, health care professional about the wound?

Does the wound appear to be healing or getting worse?

Do you have a fever or other symptoms such as feeling tired or not having an appetite?

Foot wound

When did the foot wound first appear?

How long have you had it?

Describe the level of pain from the foot wound on a scale from 1 to 10 with 1 being minimal or no pain to 10 being the worst possible pain.

What have you been doing to treat the foot wound?

For what other health problems are you currently being treated?

Have you seen your doctor or health care provider about the foot wound?

What have you been instructed to do to treat the wound?

Edema

Do you have any areas of swelling around your ankles/feet/lower legs or hands?

How long have you had these areas of swelling?

Is the swelling always present?

When did the swelling start?

Does it get worse during the course of the day?

Does elevating your (feet, legs, arms/hands) improve the swelling?

Does the swelling make it difficult to wear shoes?

Do you need to take off your rings/bracelets because of hand/arm swelling?

When you press on the swollen area, is there an indentation made?

How long does it take for the indentation to go away?

When you experience this swelling, does your body weight also increase?

Are you taking any medication for the swelling such as a diuretic?

How long have you been taking this medication?

What has your doctor or health care provider told you about the cause of the swelling?

Is there anything specific that you are supposed to do when the swelling occurs?

Peripheral vascular disease

Is the color on your lower legs the same as the color on your upper legs?

Is the color of your lower legs red/brown in color?

When did you first notice this change in color of your lower legs?

Do your lower legs ache when you walk or do any other type of physical activity?

Does the color of your lower legs change when the legs are elevated? Or when standing upright?

Does the skin over your lower legs appear shiny?

Do you have hair growing over your lower legs? If not, when did the hair stop growing?

Have you seen your doctor or health care provider about the changes in color, texture, or hair amount over your lower legs?

Cold hands/fingers

How long have you experienced cold hands/fingers?

Do you smoke cigarettes?

What is the color of the skin under your fingernails right now?

Does the skin appear pink, red, or blue?

Pinch one of your fingernails and then release the pinch. How long does it take for the color to return to the area?

Have you seen your doctor or health care provider for your cold hands/fingers? What treatment has been prescribed?

Finding

Action

Skin warm, dry, and intact

Move to assessing the hair

Skin dry and itchy

Assess medications. If new medications have been started, determine if adverse reactions include skin changes. If no new medications added, then assess fluid intake.

Fluid intake: If fluid intake has changed, assess for reasons. If no changes in fluid intake, then assess dietary intake.

Dietary intake: Assess for routine dietary intake. If significant changes made to dietary intake, focus on changes which might impact skin status. If no changes in dietary intake, then assess alcohol intake.

Alcohol intake: Assess for frequency and amount of alcohol intake. Determine if itchiness is associated with ingestion of alcohol. If no changes in alcohol intake, then assess urine output.

Urine output: Assess frequency and estimated amount of urine output including frequency of voiding, color, presence of odor, etc.

Skin moist

Assess for recent infections. If no recent infection then assess for other causes to include changes in mentation, presence of a cough, or changes in body weight.

Skin breakdown/wound

Assess when the wound occurred (any precipitating factors).

Assess the length of time the wound has been present.

What does the wound look like now? Describe the color of the wound bed.

Describe the color and consistency of any wound drainage.

Describe any odor that is associated with the wound.

Estimate the size of the wound using household estimates such as the width of a finger, size of a quarter or other coin, width of an 8-ounce glass, etc.

Describe any actions taken to treat the wound. What topical medication has been applied? Has the wound been covered with a bandage or left open to air?

Describe the condition of the skin around the wound. Is it red, swollen, painful, or pale and numb?

Has the wound been seen by the doctor or health care provider? What treatment has been prescribed? Has the treatment improved the condition of the wound or made it worse?

Skin rash present

Assess location, appearance, characteristics to include color, shape, and if pruritus is present. Then assess for potential causes.

Dietary intake: Assess for any alterations in usual diet. If no changes have occurred, assess for medications.

Medications: Review all of the patient’s current medications. Determine if any new ones have been added that correspond to the development of the rash. If medications have not been changed, assess environmental conditions.

Environmental conditions: Have any changes been made to laundry detergent, bathing soap, shampoo, shaving cream, household cleaning products, or exposure to gardening pesticides. If no changes have occurred, assess for exposure to insects/vermin.

Exposure to insects/vermin: Have you noticed or been exposed to spiders around or in your living environment? Have you noticed or been exposed to stinging insects such as bees/wasps/hornets? Have you noticed or been exposed to mosquitos? If no exposures proceed to assess for treatment options.

Treatment options: Have you discussed the rash with your doctor or health care provider? What treatment has been prescribed? Has the treatment improved or made the condition worse?

Change in mole or skin tag

Determine the location of the mole/skin tag. Assess the previous appearance of the mole/skin tag and ask to describe how the mole/skin tag appears today. Include the following areas:

Color: What is the current color of the mole/skin tag?

Condition: Is the mole/skin tag or the skin area around the mole/skin tag bleeding? When did you notice that the mole/skin tag had changed? Is the mole/skin tag tender/painful? If so, rate the pain on a scale from 1 to 10 with one being no or minimal pain and 10 being the worst pain possible.

Actions: What have you done to treat the change in mole/skin tag? Have you discussed the mole/skin tag change with your doctor, health care provider?

Skin infection (folliculitis, carbuncle, furuncle)

Where is the skin infection located?

How long has this infection been present?

What does the skin area look like?

Describe the condition of the skin around the infection.

Describe any drainage coming out of the skin infection area.

Rate the pain caused by the skin infection on a scale from 1 to 10 with one being minimal or no pain to 10 being the worst possible pain.

Describe what has been done to treat the skin infection.

Have you discussed the skin infection with your doctor, health care professional? What treatment has been prescribed? Has the treatment improved the skin infection or made it worse?