Integumentary System Assessment

Hair: Inspection and Palpation

You might begin with a brief inspection of the hair, but this is typically done in combination with palpation. Always ask permission to touch. Move the hair around while observing the scalp and strands of hair; when looking for lice or nits, it is helpful to use a comb. 

Steps for inspecting and palpating hair include:

  1. Inspect and palpate for hair colour and texture
    • Keep in mind that hair can vary greatly in terms of colour and texture. Note any variations in hair colour not attributable to hair dye, any colour patches or other inconsistencies, hair texture, and the integrity of the scalp. If you have a concern, it can be helpful to first ask the client what their normal or baseline hair colour and texture is.
    • Note any excessive dryness or oiliness of the hair and scalp or any areas of the scalp that are not intact. 
  1. Inspect and palpate for hair distribution
    • Hair patterns should be consistent without patches of hair or hair loss. However, keep in mind that as a person ages, it is natural for hair to thin and for some people to experience bald areas on the scalp particularly when it is associated with male-pattern baldness. 
    • Abnormal findings may include unexplained hair loss on the scalp and the body. Hair loss can be the result of certain conditions and medications. Any hair tufts on the body that are inconsistent with the rest of the hair distribution, such as patches of hair on the scapula, are considered abnormal findings. Hirsutism refers to excessive hair growth on the body. Alopecia refers to patches of baldness or total absence of hair on the scalp. Hair loss on the legs, particularly the toes, can be affected by peripheral vascular disease (you will learn more about this in another chapter).
  1. Inspect and palpate for lesions and other issues. Use a systematic approach generally starting from the midline of the hairline on the forehead and making your way one side at a time to the base of the skull. Then return to the midline of the hairline of the forehead and repeat on the other side. Be sure to examine behind the ears for lesions and examine strands of hair. 
    • Normally, no lesions are present.
    • Describe any abnormal findings. For example, dandruff (seborrhea) is a common condition involving a dry flaking that can be seen on the scalp or hair. Because it flakes (or falls), it can sometimes be seen on the client’s clothing (e.g., on the shoulders). Lice may be found on the scalp at the neckline and behind the ears, while the nits (eggs) stick to strands of hair. Pilar cysts are often observed on the head. These are benign growths stemming from the hair follicle, but they can be painful and even disrupt rest.
  1. Note the findings
    • Normal findings might be documented as: “Hair colour and distribution consistent with no dryness or oiliness and no lesions present.”
    • Abnormal findings might be documented as: “Several nits located on hair strands on the posterior and left side of the head with lice behind the left ear and at the base of the neck.”

Contextualizing Inclusivity

The beauty industry and commercialism has shaped ideals and standards of what constitutes beauty, particularly for women. Facial hair removal is a pervasive cultural practice for many women, but remember that some facial hair growth is normal regardless of gender. Hair growth along the upper lip, cheeks, and chin can be a normal finding for many women. 

Consider an inclusive, anti-racist, and trauma-informed approach when assessing the hair on a client’s head. Always ask permission to touch and explain what you are doing and why. Only perform assessments when necessary, and engage the client in the process. 

Clients may have alopecia due to a medical diagnosis or treatment that has caused hair loss; hair loss can be distressing and make them feel vulnerable. There is also a cultural component to hair and headwear, which can be connected to identity, culture, and body image (e.g., Jewish men may wear a kippa, married Jewish women may wear a wig or headscarf, Sikh men and women may wear a turban, transgender individuals may wear wigs or extensions). It is important to be aware of the structural racism that continues to pervade ideals of beauty, for example affecting Black women in particular (Johnson & Bankhead, 2014). Black women may wear their hair naturally, in locs, braids, wigs, or extensions such as clip-ins and weaves, and some may use coconut oil or other oil-based products in their hair. Black women continue to be affected by structural and interpersonal racism with accompanying discrimination, judgement, and marginalization (Brown, 2018). Additionally, some Indigenous people have a spiritual connection with their hair and for that reason, along with the effects of forced cutting of hair in residential schools, and intergenerational trauma more broadly, some may consider it offensive to have their hair touched. 


Brown, S. (2018). “Don’t touch my hair”: Problematizing representations of Black women in Canada. Africology: The Journal of Pan African Studies, 12(8), 64-85.

Johnson, T., & Bankhead, T. (2014). Hair it is: Examining the experiences of Black women with natural hair. Open Journal of Social Sciences, 2, 86-100.


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