Presence of foot pallor while the leg is horizontal is indicative of poor perfusion and may be a sign of ischemia. Temperature changes of adjacent segments on the ipsilateral limb and comparisons with the contralateral limb can be made. Limb temperature can best be appreciated using the back of the examiner's hand.
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The feet, hands, fingers and toes should be examined for temperature and skin color, and the nails for evidence of fragility and pitting. Skin color and temperature can provide information about severity of limb arterial perfusion. Creager, in Vascular Medicine: A Companion to Braunwald's Heart Disease (Second Edition), 2013 Limb ischemia 6,16 Additional information regarding screening for domestic abuse can be found in Chapter 5. Also, similar findings on the forearms may be indicative of defensive injuries sustained while trying protect oneself. Although cuts and bruises are fairly common, their presence on the head, face, and neck may be an indication of physical abuse. Ischemic ulcers, thin and shiny skin, hair loss, paleness of an elevated extremity, and intense rubor when the limb assumes a dependent position are all possible manifestations of this condition. 24 Local skin changes could also be a result of chronic arterial insufficiency. This infection may be accompanied by red streaks extending proximally, which are associated with secondary lymphangitis. Local redness accompanied by local heat, edema, and tenderness that develops within a few days may be a manifestation of cellulitis, a bacterial infection. In addition to general skin color changes, local alterations can also indicate a condition that should be reported to a physician. Lastly, severely jaundiced individuals may have a greenish hue to the skin resulting from the oxidation of bilirubin to biliverdin.
2 Another example is excessive bilirubin, associated with the yellowish hue of the skin, which can result in the sclera of the eyes or mucous membranes assuming a similar hue. The bluish hue noted in the hands, feet, or nails can be of central or peripheral origin. Peripheral cyanosis results from a decrease or slowing of cutaneous blood flow, which allows for tissues to extract increased levels of oxygen from the circulating blood. Central cyanosis results from low arterial oxygen levels and is best identified by color changes in the lips, tongue, and oral mucosa. For example, there are two forms of cyanosis, central and peripheral. The physiological events may result in observable changes other than those noted in the skin. Table 8-1 summarizes these abnormal states, including the underlying physiological features and associated causes of the color. Lastly, the normal reddish color of skin is attributed to the presence of oxygenated blood being transported through the arteries and capillaries.Ĭertain skin colors may represent serious disease, including pallor (pale), cyanosis (blue), jaundice or icterus (yellow), gray, and hyperpigmentation (brown). This substance is especially concentrated in the palms of the hands and soles of the feet. Carotene found in subcutaneous fat tissue contributes to the yellowish color of the skin. Besides contributing to skin color, melanin provides protection during episodes of sun exposure.
Melanocytes, found in the deep basal layer of the epidermis, contain brown granules called melanin. Skin color varies considerably from individual to individual and is generally determined by the presence of melanocytes, carotene, oxygenated hemoglobin, and local blood flow. Boissonnault PT, DHSc, FAAOMPT, in Primary Care for the Physical Therapist, 2005 Skin Color/Condition This highlights the need for scientific studies to establish the most reliable protocol to limit background noise of this kind. Depending when and under which circumstances skin color is measured, the phenotypic trait observed might not be representative, introducing bias into biological studies. Consequently, the link between phenotype and genotype is difficult to determine, since the exact and natural pigmentation needs be assessed without these confounding parameters. Pigmentation is, however, a continuous trait and a rather unstable character, modifiable by time (age) and external parameters, such as sun exposure, UV machines, hair lotions, and dyes. Specific skin areas are usually favored, especially those with little sun exposure (eg, under arm, inner wrist), in order to get the most natural and “unacclimated” phenotype. Skin color is usually measured in scientific studies using a reflectometer, which measures how much light of a particular wavelength is reflected from the skin. King, in Current Topics in Developmental Biology, 2016 c Limitation of skin color studies: measurement difficulties and the confounding effect