Our skin is the first line of defense from the rest of the world. The integrity of the skin is very important. Upon the first interaction with our patients, our attention is on his/her skin. This can tell us quite a bit about overall health without knowing the entire history. When we perform our health assessment, there are a few things we can ask our patients to be sure all skin conditions are reviewed, including allergies to medications, topical lotions and/or soaps, or even tape or latex. Certain skin conditions such as eczema, xerosis, wounds, rashes, skin discoloration, or any other skin abnormalities should be discussed at this time. It is also important to remember that our skin may have changes with the seasons. This could be when we ask our patient what type of soaps and lotions they use, and if they are bathing every day.

The physical assessment of the skin includes temperature, moisture, color, and turgor. When there is a skin condition that needs to be documented, there are few terms that describe different lesions:
Macule – flat, less that 1 cm, non-palpable lesion that has a change of skin color
 Patch – flat, larger than 1 cm, non-palpable lesion that has a change of skin color
 Papule – elevated, flat-topped, less than 1 cm, firm, rough, superficial lesion
 Nodule – elevated, firm, palpable, larger than 0.5 cm
 Cyst – nodule that is filled with either a liquid or semisolid material
 Vesicle – palpable fluid filled blister
 Bulla – 1 cm or larger filled with serous fluid
 Pustule – elevated, superficial, filled with pus
 Wheal – transient, elevated, localized skin edema (Hess, 2010)
When performing a skin assessment, nails need to be assessed as well. Ask the patient if they have noticed any changes in his/her nails; have they become more brittle, or breaking, discolored, or misshaped. Systemic conditions may be evidenced by changes in patient’s nails.