(5) Localized red or purple changes to the skin. Vascular neoplasms,
birthmarks in Von Recklinghausen's disease, and hemorrhage into the skin can cause
the skin to be red or purple colored. Vascular neoplasms change the skin color.
Sturge-Weber neoplasms are cherry red in color. A hemangioma (a benign tumor made
up of blood vessels) may be port wine colored or bright red as in a senile hemangioma
or bright red and raised as in a strawberry birthmark. Birthmarks in Von
Recklinghausen's disease are light brown spots on the skin. These spots are
sometimes called cafe au lait spots. Spontaneous bleeding in the subcutaneous
tissues, another condition, causes the appearance of purple patches on the skin. In
petechiae, bleeding into the skin appears as purplish-red spots on the skin, nail beds,
and mucous membranes. In ecchymosis, blood from injured vessels escapes and black
and blue spots appear on the skin.
(6) Decrease in hemoglobin content. Persons suffering from anemia or
shock will have pale skin.
(7) Changes in skin color caused by pigment deposits. In jaundice, the
yellow pigmentation of the skin and/or sclera of the eye is caused by the high levels of
bilirubin (an orange-red pigment) in the blood. In carotenemia, increased carotene in
the blood causes the skin to look yellowish.
Palpate (examine by touching or pressing) the skin and note the following:
a. Skin Texture. Feel the skin to determine whether it is rough and coarse,
smooth and fine, or dry as in winter itch. Rough, coarse skin can be an indication of
hypothyroidism while smooth, fine skin can be an indication of hyperthyroidism.
b. Skin Thickness. There may be increased thickness as in corns and
calluses. Decreased skin thickness can be caused by poor blood supply to particular
areas or excessive use of steroids.
c. Elasticity. This is the ability of the skin to return to its normal position when
stretched or pulled. Loss of elasticity occurs most commonly in such areas as the back
of the hand and face. An individual who has lost weight rapidly may have loose skin.
Skin loses elasticity as part of the process of aging.
d. Hydration. If the skin is loose, wrinkled, and lax, it suggests dehydration of
the entire body, a condition called turgor. The opposite condition is edema, excess
body water stored in the skin. Firm pressure against these fluid-filled areas results in
indentation in the skin.