1.4 Describe what to look for when assessing the condition of the skin

This guide will help you answer 1.4 Describe what to look for when assessing the condition of the skin.

Checking a person’s skin condition plays a major part in keeping them healthy. Spotting small changes early often prevents problems from getting worse. Your observations help to protect the person you support. This is especially important for people who may not notice or talk about changes themselves, like older adults or people who are unwell.

Why Skin Assessment Matters

The skin is the body’s biggest organ. It acts like a barrier, protecting us from infection and helping to control body temperature. If something is wrong with the skin, it sometimes shows up before other health problems appear.

Regular skin checks:

• Help to find early signs of pressure ulcers, infections or allergies
• Support comfort by spotting dry, sore, or broken areas
• Allow you to raise concerns sooner with senior staff or healthcare professionals

What to Look For When Assessing the Skin

When you assess the condition of someone’s skin, check for a range of signs. Do this when helping with personal care, dressing, bathing or supporting with moving and positioning. Always talk to the person, ask for their consent, and respect their privacy.

Look for the following:

• Colour
• Temperature
• Texture
• Integrity (whether the skin is whole or broken)
• Moisture
• Sensation
• Swelling or changes in size and shape
• Presence of wounds, ulcers, or rashes
• Signs of infection

Let’s look at each point in detail.

Colour

Healthy skin usually matches a person’s normal shade. Any sudden or unusual changes should be reported.

Check for:

• Redness: May mean inflammation, allergic reaction, pressure, or infection. Often appears on areas like heels, hips, buttocks, or elbows.
• Blue or purple: Blue (cyanosis) suggests poor blood flow and low oxygen. Purple may also show bruising or reduced circulation. Both are warning signs that need attention.
• Yellow: Yellowing (jaundice) can point to liver problems. Check around the eyes, hands, and mouth.
• Paleness: Looks lighter than usual. This may show low blood supply, shock, or anaemia.

Note if colour changes appear once or stay for a while. If someone has darker skin, look for darkening, bluish tint, or areas that feel warmer or different to the touch.

Temperature

Skin should feel neither too hot nor too cold. Gently touch the skin with the back of your hand.

• Warm skin: May happen during fever, infection, or inflammation. Hot areas can suggest infection or a developing pressure sore.
• Cool skin: Might mean poor blood flow or shock, especially in limbs such as hands and feet.
• Cold and clammy skin: Can be serious and may be a sign of something urgent like low blood pressure or sepsis.

Report any skin that feels hotter or colder than normal, especially if it’s just in one spot.

Texture

Texture means how the skin feels under your fingers. Use a light touch.

• Smooth: Healthy skin is usually smooth and soft.
• Dry or flaky: Dryness can cause itching, cracking or soreness. Flaky patches might appear on shins, elbows, hands, or scalp.
• Rough: Feels uneven or bumpy. This may just be down to age, frequent washing or certain conditions like eczema.
• Thickened: Raised or thickened areas may come from constant scratching, friction, or health conditions like psoriasis.
• Thinning: Skin may look shiny and delicate. Thin skin is more likely to break and bruise, often in older people or those using certain medications.

Take special care with very thin or fragile skin to avoid damage.

Integrity (Is the Skin Whole or Broken?)

Integrity means checking if the skin is fully intact or open anywhere.

Look for:

• Open wounds or sores
• Cuts or grazes
• Pressure ulcers (bed sores)
• Blisters
• Cracked areas, especially round heels, elbows, or between fingers and toes

If the skin is broken, note its size, depth and position. Report all wounds, large or small.

Check dressings are clean and in place. Tell your supervisor if dressings are loose, bloodstained, too wet or missing.

Moisture

The right level of moisture keeps skin healthy. Too much or too little can cause problems.

• Dryness: Causes cracking, itching, or roughness. Dry skin may bleed and is more likely to break.
• Excess moisture: Sweat, urine, stool, or leaking wounds can make skin soggy. This weakens the skin and leads to sore, broken areas, known as moisture lesions.
• Oily skin: More common in younger people, but can happen if creams or lotions are overused.

Pay extra attention to skin that is always wet from incontinence or sweating. Clean and dry this gently and often.

Sensation

Ask the person about unusual feelings in their skin.

• Tingling or numbness: Can point to nerve problems, injury, diabetes, or poor circulation.
• Pain: If skin is sore, always check why. Pain may show infection, a worsening sore spot, or the start of a pressure ulcer. Never ignore pain.
• Itching: May indicate dryness, allergies, eczema, or infection.

If someone cannot tell you if their skin feels different, watch their face and reactions as you touch their skin.

Swelling or Changes in Size and Shape

Swelling (oedema) makes the skin look puffy, stretched or shiny. Check for:

• Puffiness around eyes, hands, feet, ankles or lower legs
• Skin that leaves a dent after pressing with a finger (known as pitting oedema)
• Swelling in one part only, which might be infection, injury, or a blood clot.

If the swelling appears suddenly, is painful, red or hot, this is an urgent concern.

Wounds, Ulcers and Rashes

Keep a close watch for visible damage, especially in people who cannot move much.

• Pressure ulcers: Often start as red or purple areas that do not turn white when pressed. They may blister, open or become deep wounds. Check bony parts like heels, sacrum (bottom of back), hips and elbows.
• Rashes: Appear as red spots, patches or blisters. Rashes may itch, spread or be a sign of allergy or infection. Look out for new or worsening rashes, especially after starting new medicines.
• Cuts, scratches and grazes: Even small injuries can get infected or cause pain, especially if someone’s skin is already fragile.
• Surgical wounds: Check for bleeding, redness, swelling, pus or stitches coming apart.

Always document the size, shape, colour, and any fluid leaking from wounds. Take note if wounds are getting bigger or smaller, and if the edges look healthy or unhealthy.

Signs of Infection

Skin infection can range from mild to serious. Early detection is key.

Look for:

• Redness spreading around a sore or wound
• Swelling
• Heat or warmth to the touch
• Pain or tenderness
• Fluid or pus leaking from the area (may look yellow, green, or smell bad)
• Fever or generally feeling unwell

If the person shows confusion, chills, or new pain with an infected wound, treat this as a medical emergency and get help at once.

Special Points for High-Risk People

Some people are more prone to skin problems than others, including:

• Older adults
• People with limited movement or who use a wheelchair or are bedbound
• Those with diabetes or poor circulation
• People taking certain medicines, like steroids, which thin the skin
• People who sweat a lot, have incontinence, or are underweight

Always check the areas most at risk: back of the head, shoulders, elbows, backbone, hips, bottom, knees, ankles and heels. If someone uses medical devices (oxygen tubes, splints, or catheters), check the skin where these touch.

Using Equipment for Skin Assessment

Assessment can include more than just looking and touching.

• Use a pen torch to see colour changes in poor lighting.
• Use a mirror for areas that are hard to see, like the back.
• If permitted, take photos for monitoring (always following local policy and getting consent first).
• Record details using diagrams in care documentation.

Recording Your Observations

Record what you see, feel and hear from the person. Be specific, accurate and objective.

Include:

• The exact part of the body checked
• The size and appearance of any wounds, bruises or rashes
• Any changes since the last assessment
• The person’s own words about how their skin feels

Do not guess or make assumptions. If you are worried or unsure, talk to a more senior team member.

What to Report and Who to Tell

Share all concerns about skin changes with your senior or nurse. This includes:

• Red or purple marks that do not fade when pressed
• Open sores or blisters
• Unusual swelling or heat
• Signs of infection (redness, pus, increased pain or fever)
• New rashes or bruises, especially if unexplained
• Broken or bleeding skin

Follow your workplace policy for reporting. If you think there is a safeguarding risk, such as unexplained bruises or injuries, report this at once.

Supporting Good Skin Health

While checking skin, you can support healthy skin by:

• Keeping skin clean and dry
• Using moisturiser on dry areas, unless told otherwise
• Changing bedding and clothing regularly
• Assisting with gentle movement or exercise, if safe
• Encouraging enough drinks and a nutritious diet

Tell a nurse or senior if the person needs special creams, dressings or equipment to prevent pressure ulcers.

Key Terms Explained

• Pressure ulcer: Also called a bedsore or pressure sore. Damage areas that form when skin is pressed against a surface for too long.
• Oedema: Swelling caused by fluid build-up.
• Cyanosis: Blue/purple skin caused by a lack of oxygen in the blood.
• Jaundice: Yellowy skin caused by high levels of bilirubin (a pigment released from red blood cells).
• Eczema: An ongoing skin condition that causes dry, itchy and sometimes inflamed patches.
• Psoriasis: A long-term condition where the skin builds up into scaly, dry patches.
• Moisture lesion: Skin breakdown caused by too much moisture, often from urine, stools or sweat.

Adapting Skin Assessment to Individual Needs

Not everyone can communicate changes in their skin, so watch closely for non-verbal signs:

• Facial expressions of pain when touched
• Pulling away or guarding an area of the body
• Increased confusion or distress

Adapt your approach for people with dementia, learning disabilities, or limited speech. Use pictures or simple language, and give plenty of time.

Legal and Professional Responsibilities

You are responsible for:

• Gaining consent before checking skin
• Respecting privacy and dignity by covering areas not being checked
• Following infection prevention best practice, like handwashing and glove use
• Reporting any changes without delay
• Recording findings accurately and securely

The Care Quality Commission (CQC) and organisations like the Nursing and Midwifery Council expect attention to detail in skin care. Poor practice can cause harm and in serious cases, lead to disciplinary action.

Final Thoughts

Regular and careful skin assessment protects the people you support from harm. Early action can make a real difference, preventing discomfort, pain, and more serious risks. Always observe, record and report even small changes. Use your knowledge to spot problems and act quickly, sharing concerns with your senior in line with local policy.

Staying alert to changes, keeping good documentation, and acting at once when issues are spotted helps keep individuals healthy, comfortable, and safe. Your role is vital in promoting dignity and wellbeing in every aspect of skin care.