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Skin assessment
Last reviewed: 08.07.2025
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Diagnosis of skin diseases and its appendages, as well as various cosmetic defects, is based on the study of the anamnesis, a thorough examination of the skin and visible mucous membranes, and, if indicated, on the results of additional clinical, instrumental and laboratory studies. The leading role in making a diagnosis is played by the examination of unaffected and affected skin. The examination should be carried out in a warm, well-lit room. A magnifying lamp is traditionally used to examine the skin in dermatocosmetology.
When analyzing the condition of unaffected skin, pay attention to its color, pattern, turgor, elasticity, moisture and the severity of sebum secretion, as well as the condition of the hair and nails.
Evaluation of skin coloration provides an opportunity to get an idea of the condition of its vessels and blood supply, as well as pigment-forming function. Normal skin has a matte shade and a peculiar color, which depends mainly on the translucency of blood in the vessels and the pigment melanin. When evaluating age-related changes in the skin, it should be taken into account that photoaging is characterized by a slightly yellowish skin tone in areas exposed to chronic insolation.
The degree of moisture and oiliness of the skin reflects the functional state of the sweat and sebaceous glands, and the pattern, turgor and elasticity - the state of the connective tissue and the severity of transepidermal water loss. Based on the combined assessment of these parameters, the skin type is determined (normal, dry, oily, combination). To assess the severity of sebum secretion, a fat test is used. It is performed at least 2 hours after thorough cleansing of the skin. Cigarette or blotting paper is used, while the sheet of paper is successively pressed to the skin of the forehead, nose, chin, and then to the left and right cheeks. If the paper remains without greasy stains, the test is considered negative, and if there are greasy stains, it is positive. When checking the state of skin turgor, a number of tests are used (taking a fold of skin, or a skin fold test, a rotational compression test, etc.). To determine elasticity, the skin is pulled into a fold and released, while recording the speed of its return to normal.
When assessing the condition of the hair, pay attention to the type of its growth (male and female type), quantity, strength. Hair growth according to the male type in women, as well as weak expression of hair growth according to the male type in men indicate the presence of endocrine disorders. In cosmetology, hirsutism is quite common in women in combination with acne, age-related skin changes and other conditions and diseases. You should pay attention to the increased growth of pigmented hair on the upper lip, chin, in the periareolar area, as well as on the abdomen below the navel.
The condition of the nail plates is assessed by their shape, surface condition, color, thickness, and strength. Normally, they are smooth, shiny, and have a uniform pink color.
To assess the condition of the oral mucosa, it is necessary to examine it in the area of the lips, cheeks, soft and hard palate, tongue, and pharynx.
When examining the skin, an assessment of cutaneous autonomic reflexes (dermographism, muscle-hair reflex) is used.
Dermographism is a reaction of the neurovascular apparatus of the skin to mechanical irritation and can be white (with vascular spasm), red (with vascular dilation) and mixed. It is known that a certain dermographism is characteristic of a number of dermatoses (for example, white dermographism is characteristic of atopic dermatitis).
The muscle-hair, or pilomotor, reflex is evoked by running a spatula over the skin or by local cooling. In response to this irritation, ephemeral follicular nodules (“goose bumps”) appear.
The nature of dermographism and the severity of the pilomotor reflex allow us to indirectly judge the predominance of the sympathetic or parasympathetic divisions of the nervous system.
If necessary, disturbances in skin sensitivity are determined by tests for temperature, tactile and pain sensitivity.
In addition to assessing the condition of the skin, its appendages and mucous membranes, it is important to consistently assess the size, consistency, mobility, and sensitivity of all subcutaneous peripheral lymph nodes accessible to palpation.
A special feature of the description of the dermatocosmetological status is the characterization of not only all the above parameters, but also signs of age-related changes in the skin.
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