By Karen Zulkowski DNS, RN, CWS

I previously discussed the need for a complete head-to-toe skin assessment. Certainly this can tell you whether or not the person is dehydrated, has open or discolored areas, and many other things about their overall health. Color, for example, can give you clues to additional problems such as vitamin and mineral deficiencies that can show on the skin.

Conditions that Cause Blanchable, Bruised or Purple Skin

In looking at color, certainly blanchable or non-blanchable is indicative of a potential stage I pressure ulcer. Bruised or purplish skin should be noted immediately, especially if found in areas of pressure. This may or may not be a suspected deep tissue injury (sDTI). Documentation on admission is critical. Otherwise, if it is in fact sDTI it will be considered to be facility-acquired.

Even if the condition isn't a sDTI, a bruise can indicate clotting issues. Perhaps the person has been on an anti-coagulant or they may be taking aspirin, NSAIDs or other medication (both prescription and over the counter) or herbal remedies that have interfered with their clotting ability. Many herbs such as ginger, parsley, and garlic can interfere with clotting. Persons may not report these herbal remedies to their health care providers as they consider them safe. Vitamin C deficiency can also result in purplish blotches on lightly traumatized areas due to capillary fragility and subepithelial hemorrhages.

Conditions that Cause Skin Redness

A zinc deficiency can result in redness of the nasolabial folds and the eyebrows. Redness in the sacral or perineal areas should also be examined closely. It can be difficult to distinguish between moisture and friction damage versus a stage I pressure ulcer. Moisture or some urinary incontinence is common but might not be talked about or readily admitted to by older adults. This is primarily a women's issue. Some urinary incontinence after sneezing or coughing has long been considered a normal part of aging in women and can be a source of embarrassment. Fortunately, today we are seeing more open discussions of the issue. Any incontinence should be checked by a physician for type. There are treatments and even over the counter medications for women to use. In addition, there are now a variety of incontinence products from light to heavy pads that can be used much more discretely than bulky adult diapers.

Maceration is another condition that may be a result of moisture-associated skin damage which can be caused by excessive perspiration, wound drainage or an ostomy that leaks. Checking between skin folds in larger patients is important and products are available to help with skin fold moisture management.

Conditions that Cause Dry Skin

On the other end of the spectrum is dry skin (xerosis). Dry skin can be from dehydration or a mineral deficiency. Persons with dry skin may also experience itching. Dry climates can exacerbate both dry skin and dehydration.

So as you are doing your skin assessment, look closely for color changes. Keep in mind skin is the largest organ of the body and can tell you a great deal about a person's overall health.

About The Author
Karen Zulkowski DNS, RN, CWS teaches an online wound course for Excelsior College, and is a consultant for Mountain Pacific Quality Improvement Organization. She has served as a Research Consultant with Billings Clinic Center on Aging, and was the Associate Director for Yale University's Program for the Advancement of Chronic Wound Care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.