Integumentary System Assessment

Health Promotion and Disease Prevention: Considerations and Interventions

Health promotion is an important component of any visit with clients. An assessment of the integumentary system is an opportunity to determine appropriate interventions, if required. Carefully consider all of the collected data, both subjective and objective. During your subjective data collection, you will have asked about risk factors, social determinants, and other considerations. Based on your critical reflection of all data, you might formulate additional questions. Together, your findings will inform your clinical judgment and help you determine the health promotion needed for a specific client.

Healthy Eating

A well-balanced diet is an important part of maintaining healthy skin, hair, and nails. Persons with substance use disorder, mental illness, and other conditions that affect nutrient absorption are at particular risk for developing vitamin deficiencies, which can lead to integumentary manifestations (see Table 10). Always use a non-judgemental approach when assessing healthy eating with all clients, including those with these conditions.

Probing questions related to diet may include:

  • Tell me about your usual diet?
  • How much fluids do you typically drink in a day? What fluids do you drink (e.g., water, caffeinated beverages, alcohol)?
  • Have you had any recent changes in your life that have affected your diet?
  • Do you have any issues accessing healthy food?
  • Do you have enough money to buy healthy food?

Table 10: Vitamin deficiencies.


Vitamin deficiency


Integumentary manifestation 


Vitamin A


“Toad skin” appearance (phrynoderma), generalized dry skin, lesions on the face, skull, and extremities.


Vitamin B2


Facial dermatitis (nasolabial folds, forehead, cheeks, and ).


Vitamin B3 (niacin)


Dermatitis, photosensitivity with eruptions, perineal lesions, thickened pigmented skin. 


Vitamin B6


Dermatitis, intertriginous rash, skin ulcerations.


Vitamin B12


Hyperpigmentation on face, palmar creases and flexures, sores in mouth, and red, swollen tongue.


Vitamin C 


Follicular hyperkeratosis with fragmented corkscrew hair, perifollicular hemorrhages, diffuse in pressure sites (e.g., buttocks), edema, red swollen gums.

Skin, Nail, and Hair Care

Tools used on the skin, hair, and nails should be cleaned regularly to prevent the spread of microorganisms. Families that share nail clippers and hair brushes should replace these tools after an infection or infestation (e.g., lice), and it is never advisable to share razors with others. Inquire about the client’s skin, nail, and hair care routine.

Probing questions related to skin, nail, and hair care may include:

  • Tell me about your usual skin care routine? Your hair routine? Your nail routine?
  • What products do you use?
  • Have you recently changed the products you use?

Environmental Health

Environmental exposures to irritants such as poison ivy, poison oak, poison sumac, stinging nettle, and wood nettle can cause contact dermatitis (inflammation of skin with burning/itching) and other rashes. Other irritants that may cause skin reactions can include soaps/detergents, perfumes, solvents, and disinfectants. Some clients may have occupations involving exposure to potent chemicals, for example those working at dry cleaners or nail salons. Others may have occupational exposure to pesticides, plastics, and other materials/chemicals that can cause skin reactions. Ask about all of these issues during your subjective assessment. 

Another important issue is skin cancer, which can be related to environmental conditions, especially sun exposure. Mole mapping and monitoring are important strategies to prevent skin cancer or identify it in early stages. Skin cancers can vary in shape, size, and presentation. A new growth or change in skin is the most common sign: a new growth that does not heal, bleeds, is painful – or a mole that evolves – are important warning signs that should prompt further assessment. Teach clients about sun protection to prevent skin cancers, including daily application of sunscreen and use of protective clothing.

Probing questions related to environmental health might include:

  • Do you have any allergies?
  • Do you spend time outside in the sun? 
  • How do you protect yourself from the sun? (e.g., sunscreen with SPF 30 or above, limiting time in sun, wearing a hat, wearing long sleeves/pants). What is the SPF?
  • Do you have a history of abnormal moles? If so, do you monitor your moles? How?
  • Do you spend time outside in long grass or treed areas? Have you noticed any ticks? How do you protect yourself from ticks? (e.g., long, cuffed pants, closed shoes).
  • Are you exposed to chemicals at your workplace? If so, what precautions do you take?

Knowledge Bites

Eruptive skin rashes caused by viruses can occur year-round in children and adults, but winter months tend to be correlated with higher rates of spread because more time is spent indoors. 


Integumentary manifestation

Associated symptoms

Hand-foot-and-mouth disease 

Painful blister-like lesions on the tongue, gums, and inside the cheeks. Rash on palms of hands, soles of feet, and occasionally on the buttocks. 

Fever, loss of appetite, sore throat, general malaise.

Roseola infantum

Pink rash with flat or raised lesions, begins on trunk and spreads to face and extremities

High fever (3–4 days), irritability, swelling of the eyelids. 


Deep red, flat rash on face and spreads down toward the trunk and extremities. Typically starts as a small, distinct lesion (red with white centre) and then coalesces into a larger lesion. After several days, the rash turns to discolouration and peeling. 

Cough, redness and irritation of the eyes, fever.


Pink/light red rash that starts on the face and spreads to the neck, trunk and extremities with spots 2–3 mm in size. May or may not be itchy. Rash lasts about 5 days. 

Low-grade fever, sore throat, runny nose, malaise, tender/swollen glands. 

Erythema infectiosum (fifth disease)

Bright red rash that starts on cheeks (slapped cheeks appearance), spreads to the trunk and extremities, and lasts for 2–4 days. Rash may return when exposed to sunlight, heat or cold, or injury to the skin. 

Low-grade fever, headache, runny nose, sore throat, itching, nausea, vomiting, diarrhea.

Varicella (chickenpox)

Itchy rash on trunk, face, armpits, extremities, inside mouth.

Typically accompanied by a fever, runny nose, cough, fatigue, joint pain. 


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