GROUP 1

PRESENTATION
BY;
BABIRYE MARY GORRETH: VU-BNS-2301-
0259-DAY
Wanyana Mercy :VU-BNS-2301-1453-DAY
Maymun Abdi Mohamud: VU-BNS-2301-
0110-DAY
Chuol Tabitha Nyalel: VU-BNS-2301-1629-
DAY
ANATOMY OF THE SKIN
The skin is the largest organ of the human body and
serves as a protective barrier between the internal
organs and the external environment.
It plays a crucial role in regulating body temperature,
preventing water loss, and providing sensory
information.
The skin is composed of three primary layers: the
epidermis, dermis, and hypodermis (subcutaneous
tissue).
EPIDERMIS:
The epidermis is the outermost layer of the skin, primarily
composed of keratinocytes, which produce the protein keratin
that helps in forming a protective layer.
The epidermis itself consists of several sub-layers:
Stratum Corneum: The outermost layer composed of dead,
flattened keratinocytes that provide a tough, protective barrier.
Stratum Lucidum: Found only in thick skin (like the palms of
the hands and soles of the feet), this layer consists of a thin,
clear layer of dead cells.
Stratum Granulosum: This layer contains keratinocytes that
are undergoing a process of degeneration and forming a
waterproof barrier by producing lipids.
CONT....
 Stratum Spinosum: Also known as the "spiny" layer,
this layer contains keratinocytes connected by
desmosomes, which give the cells a spiny appearance.
Stratum Basale (Germinativum): The deepest layer
of the epidermis, where new keratinocytes are
continuously produced. This layer also contains
melanocytes, which produce the pigment melanin
responsible for skin color, and Merkel cells, which
function in touch sensation.
THE EPIDERMIS LAYER
DERMIS
The dermis lies beneath the epidermis and is much thicker.
It is composed of two layers:
Papillary Layer: This is the upper portion of the dermis that
interlocks with the epidermis. It contains finger-like projections
called dermal papillae, which increase the surface area for the
exchange of oxygen, nutrients, and waste products between the
dermis and the epidermis. This layer also contains capillaries
and nerve endings responsible for touch sensation.
Reticular Layer: This is the deeper and thicker part of the
dermis. It contains collagen and elastin fibers, which provide
strength, flexibility, and elasticity to the skin.
This layer houses structures like:
CONT....
Blood Vessels: Supplying oxygen and nutrients to the
skin.
Nerve Endings: Providing sensory information (touch,
pain, temperature).
Hair Follicles: Where hair growth begins.
Sebaceous (Oil) Glands: Producing sebum to keep the
skin moisturized.
Sweat Glands: Helping in thermoregulation by
producing sweat.
Lymphatic Vessels: Playing a role in immune
responses.
THE DERMIS LAYER
HYPODERMIS(SUBCUTANEOUS
LAYER )
The hypodermis is the deepest layer of the skin,
composed mainly of adipose (fat) tissue and
connective tissue.
This layer serves several functions:
Insulation: Helps to conserve body heat.
Shock Absorption: Protects internal organs from
mechanical injury.
Energy Storage: Stores fat as a source of energy.
Anchorage: Connects the skin to underlying structures
like muscles and bones.
HYPODERMIS LAYER
PHYSIOLOGY OF THE SKIN
1. Protection
The skin acts as the first line of defense against physical,
chemical, and biological hazards.
Barrier Function: The outermost layer of the skin, the
stratum corneum (part of the epidermis), consists of
dead keratinocytes filled with keratin, which creates a
tough, water-resistant barrier. This prevents the entry of
pathogens (bacteria, viruses, fungi) and minimizes water
loss from the body, which is crucial for maintaining fluid
balance.
Acid Mantle: The skin’s surface has a slightly acidic pH
(around 4.5 to 6.2), creating an acid mantle that inhibits
the growth of harmful bacteria and fungi.
Melanin Production: Melanocytes in the epidermis
produce melanin, a pigment that protects the skin from
harmful ultraviolet (UV) radiation. Melanin absorbs UV
rays and reduces the risk of DNA damage in skin cells,
which could lead to skin cancer.
2. Sensation
The skin is rich in sensory receptors that detect various
stimuli, making it a crucial organ for the sense of touch.
Mechanoreceptors: These receptors detect
mechanical stimuli, such as touch, pressure, and
vibration. Examples include:
• Merkel cells: Detect light touch.
• Meissner's corpuscles: Detect fine touch and low-
frequency vibration.
CONT.... • Pacinian corpuscles: Detect deep pressure and
high-frequency vibration.
• Ruffini endings: Detect skin stretch and sustained
pressure.
Thermoreceptors: These receptors detect temperature
changes, allowing the body to respond to hot or cold
environments.
Nociceptors: These receptors detect painful stimuli,
alerting the body to potential damage from harmful
CONT....
3. Thermoregulation
The skin plays a vital role in regulating body temperature through various
mechanisms:
Sweat Production: Eccrine sweat glands secrete sweat, which
evaporates from the skin's surface, cooling the body. This process is
especially important during exercise or in hot environments.
Vasodilation: When the body is overheated, blood vessels in the dermis
dilate (widen), allowing more blood to flow near the skin's surface. This
increases heat loss through radiation and convection, helping to cool the
body.
Vasoconstriction: In cold environments, blood vessels constrict, reducing
blood flow to the skin. This conserves heat by minimizing heat loss through
the skin, helping to keep the body warm.
Arrector Pili Muscle: When the body is cold, tiny muscles attached to
hair follicles (arrector pili) contract, causing hairs to stand up
(goosebumps). This traps a layer of air close to the skin, providing
CONT....
4. Excretion
The skin plays a role in excreting waste products through
sweat:
Sweat Composition: Sweat produced by eccrine
glands contains water, salts (mainly sodium chloride),
urea, ammonia, and other waste products. Through
sweating, the skin helps to remove these substances
from the body.
Regulation of Electrolytes: The excretion of salts
through sweat helps to maintain electrolyte balance in
the body.
CONT....
5. Synthesis of Vitamin D
The skin is involved in the synthesis of vitamin D,
which is essential for calcium absorption and
bone health:
UV Radiation and Vitamin D Synthesis:
When the skin is exposed to UVB radiation from
sunlight, a cholesterol derivative (7-
dehydrocholesterol) in the skin is converted into
vitamin D3 (cholecalciferol). This is then
transported to the liver and kidneys, where it is
converted into the active form of vitamin D
(calcitriol).
Role of Vitamin D: Vitamin D is crucial for the
absorption of calcium and phosphorus from the
intestines, promoting bone health and
preventing conditions like rickets and
osteoporosis.
CONT....
6. Immune Response
The skin is an active participant in the immune system, helping to
protect the body from infections:
Langerhans Cells: These are specialized dendritic cells found in
the epidermis. They capture and present antigens (foreign
substances) to T cells, initiating an immune response.
Keratinocytes: These cells also play a role in immune function
by producing antimicrobial peptides, cytokines, and chemokines,
which help to recruit immune cells to the site of infection or
injury.
Physical Barrier: The intact skin acts as a physical barrier that
prevents the entry of pathogens. If the skin is breached, such as
through a cut, the immune system is rapidly activated to prevent
infection.
7. Wound Healing
CONT....
The skin has the remarkable ability to repair
itself through a complex wound healing
process that involves several stages:
Hemostasis: Immediately after an injury,
blood vessels constrict, and a clot forms to
stop bleeding.
Inflammation: Immune cells, such as
neutrophils and macrophages, migrate to the
wound site to clear debris and prevent
infection.
Proliferation: New tissue forms as fibroblasts
produce collagen, and new blood vessels
develop (angiogenesis). Epithelial cells also
migrate across the wound to restore the
epidermis.
Remodeling: The wound matures as collagen
is reorganized and the tissue strengthens,
CONT....
8. Water and Lipid Homeostasis
The skin is essential for maintaining water balance and preventing
excessive water loss:
Stratum Corneum: The outermost layer of the epidermis, with
its lipids and dead keratinocytes, forms a barrier that minimizes
water loss through evaporation (trans-epidermal water loss).
Sebum Production: Sebaceous glands produce sebum, an oily
substance that helps to maintain the skin's hydration by
preventing water loss. Sebum also keeps the skin soft and
pliable.
SUBJECTIVE DATA OF
THE SKIN
When assessing a patient's skin, the following subjective
data should be gathered through targeted questions:
1. History of Skin Issues
 Have you experienced any skin problems in the past
(e.g., rashes, eczema, psoriasis)?
 Do you have a history of skin allergies or sensitivities?
2. Current Symptoms
 Are you experiencing any itching, burning, or pain in
your skin?
 Have you noticed any changes in your skin color,
texture, or temperature
3. Lesions or Changes
 Have you noticed any new moles, spots, or growths on
your skin?
 Have any existing lesions changed in size, shape, or
color?
CONT....
4. Sun Exposure
 How often are you exposed to sunlight? Do you use
sunscreen?
 Have you had any sunburns or tanning bed use in the
past?
5. Personal and Family History
 Do you have any family history of skin conditions (e.g.,
skin cancer, dermatitis)?
 Are you currently taking any medications or supplements
that may affect your skin?
6. Lifestyle Factors
 What is your daily skincare routine?
 Do you have any dietary habits that may impact your
skin health (e.g., hydration, nutrition)?
7. Systemic Symptoms
 Have you experienced any systemic symptoms such as
fever, fatigue, or weight loss that may be related to skin
EXAMPLE
 Subjective data on a specific type of rash, such as
eczema (atopic dermatitis)
History of Present Illness (HPI):
 Onset: When did the rash first appear?
 Location: Where on the body is the rash located?
Common areas for eczema include the face, neck,
hands, and the bends of elbows and knees.
 Duration: How long has the rash been present?
 Severity: How intense is the itching or discomfort on a
scale of 1-10?
 Aggravating Factors: What makes the rash worse?
(e.g., heat, certain fabrics, sweating, stress, certain
foods)
 Relieving Factors: What seems to help alleviate the
symptoms? (e.g., moisturizing, cool compresses,
avoiding certain triggers)
 Progression: Has the rash spread or worsened over
time?
CONT....
Associated Symptoms: Is there any associated pain, oozing, or infection? Does
the patient experience dry skin in other areas or hay fever/asthma?
Past Medical History:
History of similar rashes: Have you experienced similar skin issues before?
Family history: Is there a family history of eczema, asthma, or allergies?
Other skin conditions: Do you have any other diagnosed skin conditions?
Social History:
Daily Activities: Have you had to alter your daily routine due to the rash (e.g.,
avoiding certain activities or clothing)?
Exposure: Have you been exposed to any new skin products, detergents, or
environmental factors that may have triggered the rash?
Stress: Have you experienced increased stress levels recently?
Review of Systems:
General Skin: Any other changes in skin texture or color? Any signs of infection?
• Allergies: Are there known allergies (e.g., to food, pollen, pets) that might
correlate with flare-ups?
OBJECTIVE DATA 1. Inspection
(WHAT DO YOU Color: Observe the overall skin
INSPECT, PALPATE, color and any variations (e.g.,
PERCUSS AND pallor, erythema, cyanosis,
AUSCULTATE) jaundice).
Lesions: Examine for any rashes,
moles, or other lesions, noting
their size, shape, color, and
distribution.
Texture: Assess the texture of
the skin (smooth, rough, dry, oily).
Hydration: Look for signs of
dehydration (dryness, flakiness) or
overhydration (swelling, edema).
CONT....
2. Palpation
 Temperature: Use the back of your
hand to assess skin temperature
(warm, cool).
 Moisture: Check for dryness or
excessive moisture (sweating).
Turgor: Assess skin turgor by pinching
the skin to see how quickly it returns to
its normal position (indicates hydration
status).
Lesion Characteristics: Palpate any
lesions to assess their texture (e.g.,
raised, flat, indurated) and tenderness.
CONT....
3. Percussion
Not typically performed on the skin: However, percussion
may be used to assess underlying structures (e.g., checking for
fluid in subcutaneous tissues).
4. Auscultation
Not typically performed on the skin: Auscultation is
generally not applicable to skin assessment but may be relevant
if assessing underlying vascular structures (e.g., bruits over large
vessels).
IDENTIFYING AND
INTERPRETING NORMAL AND
ABNORMAL VARIATIONS IN SKIN
NORMAL VARIATIONS
1. Skin Color:
 Normal skin tones range from
pale to dark, with variations
based on ethnicity.
Uniform pigmentation is typical.
[Link]:
Smooth and even texture is
normal.
Slightly oily or dry skin can be
typical based on individual skin
type.
CONT....
3. Temperature:
 Warm to the touch is normal;
slight variations can occur
based on environmental factors.
4. Moisture:
Skin should be adequately
hydrated, not excessively dry or
overly moist.
1. Color Changes:
 Erythema: Redness indicating
ABNORMAL inflammation or infection.
 Cyanosis: Bluish tint indicating
VARIATIONS poor oxygenation.
 Jaundice: Yellowing indicating
liver dysfunction.
[Link]:
 Rashes: Unexplained rashes
can indicate allergic reactions
or infections.
 Moles: Changes in size, shape,
or color of moles may indicate
malignancy (ABCDE criteria:
Asymmetry, Border irregularity,
Color variation, Diameter
>6mm, Evolving).
CONT....
3. Texture Changes:
 Rough or Scaly Skin: May indicate
conditions like eczema or psoriasis.
 Thickened Skin: Can suggest chronic
irritation or conditions like lichen simplex
chronicus.
4. Temperature Variations:
 Coolness: May indicate poor circulation or
shock.
 Localized warmth: Can indicate infection or
inflammation.
5. Moisture Variations:
 Excessive dryness: Can indicate
dehydration or skin conditions like ichthyosis.
 Excessive moisture: Can indicate sweating
ANATOMY
OF HAIR
Hair is a filamentous
structure made of keratin, a
protein, and is found on most
parts of the human body.
Each hair is composed of a
visible part called the hair
shaft and a portion beneath
the skin called the hair root,
which is embedded within a
hair follicle.
CONT....
1. Hair Shaft
The hair shaft is the visible part of the hair that
extends above the skin surface. It consists of three
main layers:
 Cuticle: The outermost layer of the hair shaft is
called the cuticle. It is made up of overlapping,
transparent, flat cells (like shingles on a roof) that
protect the inner layers of the hair shaft. The cuticle
is responsible for the shine and smoothness of the
hair. When the cuticle is damaged, the hair can
become dry, brittle, and prone to breakage.
 Cortex: Beneath the cuticle lies the cortex, which is
the thickest layer of the hair shaft. The cortex is
composed of long keratin filaments and contains
melanin (the pigment that gives hair its color). The
structure of the cortex determines the strength,
elasticity, and texture of the hair. For example, curly
hair has a different arrangement of keratin filaments
CONT....
 Medulla: The innermost layer of the hair shaft is
the medulla, which consists of loosely packed
cells and air spaces. Not all hair types have a
medulla; it is often absent in fine or thin hair.
2. Hair Root
 The hair root is the part of the hair located
beneath the skin surface, within the hair follicle.
The hair root is responsible for the growth of hair.
It consists of several important structures:
Hair Follicle: The hair follicle is a tunnel-like
structure in the epidermis (outer skin layer) that
extends down into the dermis (inner skin layer).
The follicle surrounds the hair root and provides
the environment necessary for hair growth. The
hair follicle has two key components:
CONT....
 Outer Root Sheath: This is the outermost layer of the
follicle that provides structural support and protection to the
hair root.
Inner Root Sheath: This layer lies between the outer root
sheath and the hair shaft. It helps in molding the growing hair
shaft and guides its upward movement through the follicle.
ii. Hair Bulb: At the base of the hair root is the hair bulb, a
rounded, bulbous structure that contains the dermal papilla
and the matrix cells responsible for hair growth.
 Dermal Papilla: The dermal papilla is a small, finger-like
projection of connective tissue located at the base of the
hair bulb. It contains blood vessels that supply nutrients and
oxygen to the matrix cells, which are crucial for hair growth.
Matrix Cells: These are rapidly dividing cells located around
the dermal papilla. As these cells divide and push upward,
they differentiate into the various layers of the hair shaft. The
matrix cells are responsible for the formation of the hair shaft
and the hair's color (through the production of melanin by
melanocytes).
CONT....
Sebaceous Glands: These glands are associated
iii.
with the hair follicle and secrete sebum, an oily
substance that lubricates the hair and skin. Sebum helps
keep the hair flexible and provides a protective barrier
against moisture loss.
Iv. Arrector Pili Muscle: This tiny, smooth muscle is
attached to the hair follicle. When it contracts (in
response to cold or emotional stimuli), it causes the hair
to stand on end, resulting in "goosebumps." This action
also helps to trap air and provide insulation.
HAIR GROWTH CYCLE
Hair growth occurs in a cyclical manner, and the
hair follicle undergoes three main phases:
Anagen Phase (Growth Phase): This is the
active growth phase of the hair cycle, during
which the hair follicle is fully functional, and
matrix cells are actively dividing. Hair can remain
in the anagen phase for several years (2-6 years
for scalp hair), and during this time, the hair
grows continuously. The length of the anagen
phase determines the maximum length of the
hair.
Catagen Phase (Transition Phase): This is a
short transitional phase that lasts for a few
weeks. During the catagen phase, the hair follicle
CONT....
Telogen Phase (Resting Phase): This is the
resting phase of the hair cycle, during which the
hair follicle remains dormant for about 3 months.
The hair remains in the follicle but is not actively
growing. Eventually, the old hair is shed, and the
follicle re-enters the anagen phase to begin
producing a new hair.
TYPES OF HAIR
There are three main types of hair found on
the human body:
Lanugo: This is the fine, soft hair that covers the
body of a fetus during development in the womb.
It is usually shed before birth or shortly thereafter.
Vellus Hair: Vellus hair is fine, short, and lightly
pigmented. It covers most of the body and plays
a role in regulating body temperature. Vellus hair
is not associated with sebaceous glands and is
less noticeable than terminal hair.
CONT....
Terminal Hair: Terminal hair is thick, coarse, and
pigmented. It is found on the scalp, eyebrows,
eyelashes, and other parts of the body such as the
armpits and pubic area. Terminal hair is associated
with sebaceous glands and is hormonally
regulated, with growth patterns that change
during puberty and adulthood.
HAIR COLOR
Hair color is determined by the amount and type of
melanin produced by melanocytes in the hair
bulb:
Eumelanin: This type of melanin gives hair black
or brown color. The concentration and distribution
of eumelanin determine the darkness of the hair.
Pheomelanin: This type of melanin gives hair a
red or yellowish color. A higher concentration of
PHYSIOLOGY OF THE HAIR
Hair serves several important functions,
including:
 Protection: Hair on the scalp protects the head
from UV radiation and physical trauma. Eyelashes
and eyebrows shield the eyes from dust and
sweat.
Thermoregulation: Hair helps to maintain body
temperature by providing insulation. For example,
scalp hair reduces heat loss, and body hair traps a
layer of air close to the skin.
Sensory Function: Hair follicles are associated
with nerve endings, making hair sensitive to touch.
This allows hair to detect light touches or
movements, which can alert the body to the
presence of insects or other external stimuli.
Social and Sexual Signaling: Hair plays a role in
social interactions and sexual attraction. The
appearance, color, and style of hair can influence
[Link] Hair
SUBJECTIVE DATA Health:
OF HAIR

 Have you noticed any changes in your hair

recently (e.g., texture, thickness)?
Do you have any concerns about your hair?
[Link] Loss or Growth:
Are you experiencing hair loss or thinning? If
so, when did it start, and where is it occurring?
Have you noticed any excessive hair growth in
unusual areas?
[Link] Care Routine:
What products do you use on your hair
(shampoo, conditioner, styling products)?
How often do you wash and style your hair?
CONT....
[Link] Health:
 Do you have any issues with your scalp,
such as itching, flaking, or redness?
[Link] and Treatments:
Are you taking any medications or using
treatments that might affect your hair (e.g.,
hormone therapy, supplements)?
[Link] and Lifestyle:
Has your diet or stress level changed
recently, and do you believe it affects your
hair?
Do you frequently dye or chemically treat
your hair?
[Link] History:
OBJECTIVE DATA
[Link]:
 Hair Distribution: Look for evenness
or areas of thinning/balding.
Hair Color: Note any changes, such
as graying or unusual pigmentation.
Hair Texture: Observe whether the
hair is dry, brittle, oily, or normal.
Hair Shaft: Check for signs of
damage, such as split ends or
breakage.
Scalp Condition: Inspect for redness,
scaling, lesions, or signs of infection
(e.g., dandruff, lice)
CONT....
2. Palpation:
Hair Texture: Feel the hair to assess for
coarseness, dryness, or softness.
Scalp Tenderness: Gently palpate the
scalp for any tenderness, lumps, or bumps.
Hair Strength: Tug on a small section of
hair to evaluate strength and elasticity.
[Link]:
Not typically performed for hair
assessment. Hair and scalp conditions
generally do not require percussion.
4. Auscultation:
Not applicable for hair assessment.
Auscultation is not used for evaluating hair
or scalp conditions.
IDENTIFYING AND
INTERPRETING NORMAL AND
ABNORMAL VARIATIONS OF HAIR
NORMAL HAIR VARIATIONS
1. Color:
Hair color consistent with age,
ethnicity, and genetic background.
Gradual graying as part of the aging
process.
2. Texture:
Smooth, resilient, and consistent
texture without brittleness.
Appropriate oiliness or dryness,
depending on individual variation.
CONT....
3. Distribution:
 Even distribution of hair across the scalp and
other body areas, appropriate for age and
gender.
No bald spots or patches of missing hair.
[Link] Condition:
Clean, without redness, flaking, scaling, or
lesions.
No visible infestations, such as lice or nits.
5. Hair Shaft:
 Hair shafts appear intact, without signs of
breakage or split ends.
ABNORMAL
VARIATIONS
1. Color:
 Sudden Graying or Loss of Pigment: May
indicate underlying health conditions like vitiligo
or hormonal imbalances.
Patchy Pigmentation: Could suggest conditions
like alopecia areata or fungal infections.
2. Texture:
Brittle or Fragile Hair: May be due to
malnutrition, thyroid disorders, or excessive
chemical treatments.
Overly Oily or Extremely Dry Hair: Can
indicate sebaceous gland disorders or skin
conditions like dermatitis.
CONT....
3. Distribution:
 Alopecia (Hair Loss): Can be localized (alopecia
areata) or generalized (telogen effluvium),
indicating conditions like stress, autoimmune
diseases, or hormonal imbalances.
 Hirsutism (Excessive Hair Growth): Unusual hair
growth in women, often due to hormonal imbalances
or conditions like polycystic ovary syndrome (PCOS).
4. Scalp Condition:
 Scaling or Flaking: Indicates dandruff, seborrheic
dermatitis, or psoriasis.
 Redness or Inflammation: May suggest infections,
allergic reactions, or skin conditions.
 Lesions or Sores: Could indicate infections, such
as folliculitis or tinea capitis (scalp ringworm).
 Lice or Nits: Presence of lice infestations, which
require treatment
CONT....
3. Hair Shaft:
Split Ends or Fractured
Hair: Often due to damage
from heat styling,
chemicals, or poor
nutrition.
Excessive Shedding or
Thinning: Could be due to
stress, nutritional
deficiencies, or underlying
medical conditions like
hypothyroidism or anemia.
ANATOMY OF THE NAILS
Nails are made of keratin, a tough protein that also forms hair
and the outer layer of skin.
Below is a detailed explanation of the anatomy of nails:
1. Nail Plate
The nail plate is the visible, hard part of the nail that sits on top of
the nail bed. It is composed of densely packed layers of
keratinized cells. The nail plate has several key features:
• Free Edge: The distal (end) part of the nail that extends beyond
the fingertip. This part can be trimmed.
• Nail Body: The central part of the nail plate, which is attached to
the nail bed. It is usually smooth and slightly convex.
• Lunula: The white, crescent-shaped area at the base of the nail
plate. The lunula is the visible part of the matrix and is most
prominent on the thumb.
CONT....
2. Nail Bed:
The nail bed is the skin beneath the nail plate. It is
rich in blood vessels, giving the nail its pinkish color.
The nail bed plays an important role in nourishing the
nail and supporting its growth.
3. Nail Matrix:
The nail matrix is located beneath the skin at the
base of the nail, under the cuticle. It is the most
critical part of the nail, as it is responsible for
producing new nail cells. As the matrix generates new
cells, they harden and push the older cells forward,
causing the nail to grow. Damage to the nail matrix
can affect nail growth and appearance.
CONT....

[Link] (Eponychium)
The cuticle is the thin layer of skin that overlaps and
protects the nail matrix. It acts as a barrier against
infections by sealing the area between the nail and skin.
5. Nail Folds
Nail folds are the folds of skin that frame and support the
sides of the nail. There are two main types:
• Lateral Nail Folds: These are the skin folds on the sides
of the nail plate.
• Proximal Nail Fold: This is the fold of skin at the base of
the nail, covering the nail root and matrix. The cuticle
extends from the proximal nail fold.
CONT....
6. Hyponychium
The hyponychium is the thickened layer of skin located
underneath the free edge of the nail, where the nail
separates from the skin at the fingertip. It acts as a
protective barrier against pathogens and debris.
7. Nail Root
The nail root is the portion of the nail that is embedded
under the skin and lies beneath the proximal nail fold.
It is the beginning of the nail plate, and it grows out
from the matrix.
8. Perionychium
The perionychium refers to the skin that surrounds the
nail plate. It includes the lateral nail folds and the
proximal nail fold. The perionychium plays a protective
role, preventing external damage to the nail.
PHYSIOLOGY OF THE NAIL
Nail Plate; Provides a strong, protective
covering for the fingertip and aids in
picking up small objects.
Nail Bed; Supports the nail plate and
provides nutrients for nail growth. The
pinkish color of the nail is due to the blood
supply in the nail bed.
 Matrix (Nail Root):The primary site of
nail growth. Cells in the matrix divide and
harden, forming the nail plate as they
move outwards.
Lunula; Part of the matrix, the lunula is
visible and indicates healthy nail growth.
 Cuticle (Eponychium); Protects the
matrix from bacteria and other pathogens.
[Link]:
Have you noticed any changes in
the color, shape, or thickness of
SUBJECTIVE your nails?
DATA OF NAILS Are your nails more brittle, soft, or
prone to splitting than usual?
[Link]:
Have you observed any changes in
the growth rate of your nails?
Do your nails seem to grow faster
or slower than before?
[Link] or Pain:
Do you experience any pain,
tenderness, or discomfort around
your nails or cuticles?
Are your nails sensitive to touch or
CONT....
4. Nail Care Practices:
 How often do you trim or groom your nails?
 Do you use any specific products on your nails (e.g., polish,
hardeners)?
 Have you recently changed your nail care routine?
5. Infections:
 Have you ever had a nail infection, fungus, or ingrown nails?
 Do you notice any redness, swelling, or discharge around your
nails?
6. Lifestyle Factors:
 Do you bite your nails or have other habits that might affect
them?
 Do you think your diet, stress levels, or overall health impact
your nails?
7. Medical History:
 Do you have any medical conditions (e.g., psoriasis, diabetes)
that might affect your nails?
 Are you taking any medications that could influence your nail
health?
OBJECTIVE DATA
1. Inspection
 Color:
• Check for any discoloration (e.g., pale, cyanotic,
yellow, brown, or black nails).
• Assess the nail bed for signs of capillary refill
(normal color should return within 2 seconds
after pressing the nail).
 Shape and Contour:
• Examine the nail shape (e.g., clubbing, spoon-
shaped nails, pitting).
• Look for irregularities in the nail surface, such
as ridges or deformities.
• Assess the curvature of the nail plate (normal
nails should have a slight convex curve).
 Thickness:
• Note any thickening of the nails (e.g.,
onychomycosis) or thinning.
CONT....
 Hygiene and Grooming:
• Observe the cleanliness of the nails and
surrounding skin.
• Check for signs of nail-biting or trauma.
 Cuticles and Surrounding Skin:
• Inspect the cuticles for any inflammation,
redness, or infection.
• Assess the surrounding skin for signs of
dryness, cracks, or lesions.
 Lesions or Abnormalities:
• Look for any abnormalities, such as
splitting, peeling, or detachment of the
nail plate (onycholysis).
• Check for subungual hematomas (blood
under the nail) or other lesions.
CONT....
2. Palpation
 Nail Texture:
• Palpate the nails to assess their texture (smooth,
rough, brittle).
 Nail Firmness:
• Gently press on the nails to check for firmness or
any abnormal softness.
 Tenderness:
• Palpate the nails and surrounding tissues to
assess for tenderness or pain.
 Capillary Refill:
• Perform the capillary refill test by pressing on the
nail bed and observing how quickly the color
returns (normal is less than 2 seconds).
4. Percussion; Percussion is generally not used in
nail assessment.
5. Auscultation; Auscultation is also not applicable to
IDENTIFYING AND INTERPRETING NORMAL
AND ABNORMAL VARIATIONS OF THE NAILS

NORMAL NAIL VARIATIONS

[Link]:
 Nails are generally pink with a white lunula (the
crescent shape at the base of the nail).
 Capillary refill should be less than 2 seconds after
pressing on the nail.
2. Shape and Contour:
 The nails are slightly convex, with a smooth surface.
 The nail beds are firmly attached to the underlying
skin.
3. Thickness:
 Nails are of consistent thickness, neither too thick
nor too thin.
Cuticles and Surrounding Skin:
4.
 The cuticles are intact without redness or swelling.
 The surrounding skin is healthy and free from cracks
or lesions.
[Link]:
CONT..  Nails feel smooth to the touch, with no roughness or
irregularities.
..
6. Growth:
 Nails grow at a normal rate (approximately 3-4
millimeters per month for fingernails).
ABNORMAL
VARIATIONS
[Link] Changes:
 Pale or White Nails: May indicate
anemia or liver disease.
Cyanotic (Blue) Nails: Suggest
poor circulation or respiratory issues.
Yellow Nails: Could be a sign of
fungal infections, psoriasis, or
respiratory disorders.
Brown/Black Nails: May indicate
trauma, subungual hematoma, or
melanoma.
Beau’s Lines: Horizontal grooves or
indentations across the nail, often
linked to systemic illness or trauma.
CONT....
[Link] and Contour Abnormalities:
 Clubbing: Nails become rounded and
bulbous, often associated with chronic
hypoxia or lung disease.
Spoon-Shaped Nails (Koilonychia): Nails
curve upward like a spoon, potentially
indicating iron deficiency anemia.
Pitting: Small depressions in the nail surface,
commonly seen in psoriasis.
Onycholysis: Detachment of the nail from
the nail bed, often due to trauma, fungal
infection, or thyroid disease.
[Link] Changes:
 Thickened Nails: Could indicate fungal infections, psoriasis, or
vascular issues.
Thin/Brittle Nails: May result from nutritional deficiencies,
CONT.... thyroid problems, or frequent exposure to water/chemicals.
[Link] and Surrounding Skin Abnormalities:
Inflamed Cuticles (Paronychia): Red, swollen cuticles often
due to infection.
Hangnails: Torn skin near the cuticle, possibly from dry skin or
trauma.
CONT....
[Link]/Abnormalities:
 Splinter Hemorrhages: Small, red streaks
under the nails, potentially indicating
endocarditis or trauma.
Leukonychia: White spots or lines on the
nails, often due to trauma or zinc deficiency.
Onychomycosis: Fungal infection leading to
thick, discolored, and brittle nails.
6. Nail Growth Abnormalities:
Slow Growth: May indicate poor circulation
or malnutrition.
Rapid Growth: Can be seen in conditions
like psoriasis or pregnancy.
1.