Assessing a patient’s skin color is an important part of the nursing process. Noticing and documenting any changes or abnormalities in skin color can provide clues about a patient’s health status. When describing skin color in nursing documentation, it is important to be as objective and descriptive as possible.
What is Skin Color?
Skin color is determined by a pigment called melanin, which is produced by cells in the skin called melanocytes. Melanin comes in different forms and ratios that determine skin color. The most common types of melanin are:
- Eumelanin – Brown and black pigments
- Pheomelanin – Red and yellow pigments
The ratio and distribution of these melanins determine the natural skin color. Darker skin has more eumelanin while lighter skin has more pheomelanin. Skin color can vary widely between different ethnic groups based on genetics.
Importance of Assessing Skin Color
Assessing any changes or abnormalities in a patient’s natural skin tone is an important part of physical assessment and monitoring. Key reasons why nurses need to pay close attention to skin color include:
- Changes in skin color can indicate underlying health issues.
- Abnormal skin color may be a side effect of certain medications or treatments.
- Altered skin color can signify impaired organ function.
- Some skin color changes may indicate a nutritional deficiency.
By carefully observing and documenting skin color, nurses can detect problems early and initiate any needed interventions. Subtle changes in skin color over time may also provide diagnostic clues.
How to Objectively Describe Skin Color
When documenting skin color for medical and nursing records, subjective or vague descriptions should be avoided. Examples of subjective descriptions include: pale, jaundiced, flushed, etc. Instead, aim for more objective descriptions.
Here are some tips for accurately describing skin color in nursing notes:
- Use standard validated skin color palettes – These provide a consistent frame of reference when documenting.
- Note the locations on the body – Be precise about where skin color changes are observed.
- Use descriptive terminology – For example, erythema, cyanosis, mottling.
- Compare to the patient’s normal skin tone – Look for any variations from their baseline.
- Include the extent and boundaries – Note if skin color changes are generalized or localized.
Skin Color Palettes for Reference
Using a consistent skin color palette as a reference point helps standardize documentation between different nurses. Some validated tools include:
Fitzpatrick Skin Type Scale
Developed in 1975 by Harvard dermatologist Thomas Fitzpatrick, this skin typing scale categorizes a person’s complexion and tolerance to sunlight. The scale ranges from very fair (burns easily) to very dark (almost never burns).
| Skin Type | Tone | Characteristics |
|---|---|---|
| Type I | White/Pale | Always burns, never tans |
| Type II | White/Fair | Usually burns, minimally tans |
| Type III | Cream White | May burn, gradually tans |
| Type IV | Beige/Light Brown | Rarely burns, tans easily |
| Type V | Brown | Very rarely burns, tans darkly |
| Type VI | Dark Brown/Black | Almost never burns, deeply pigmented |
Munsell Color System
This scientifically standardized approach to identifying color consists of three components: hue, value, and chroma. It allows skin colors to be specified by metric values instead of subjective descriptors.
- Hue – The basic color (red, yellow, green, blue, purple).
- Value – Relative lightness/darkness ranging from 0 (pure black) to 10 (pure white).
- Chroma – Intensity/saturation of the hue from 0 (weak) to 20 (vivid).
For example, a pale Caucasian skin tone could be documented as 10YR 7/4. This denotes a yellow-red hue, with a value of 7 and chroma of 4.
Massey Color Chart
Developed for dermatology, this skin tone scale consists of numbered and lettered skin hue samples from very fair to very dark. Letters indicate the hue (pink, red, copper) while numbers signify darkness. It allows skin colors to be systematically documented by referencing the chart.
Describing Common Skin Color Changes
In addition to the patient’s baseline skin tone, nurses should clearly document any areas of color change. Here are some examples:
Pallor
An abnormal paleness compared to normal skin color. May indicate anemia, shock, vasoconstriction, etc. Document the locations and extent of pallor or pale areas.
Cyanosis
Bluish discoloration of the skin and mucous membranes indicating poor circulation/oxygenation. Note if cyanosis is peripheral, central, or circumoral.
Erythema
Reddening of the skin due to inflammation, infection, or irritation. Note the locations, size, shape, and borders of any erythematous areas.
Jaundice
Yellowish discoloration of the skin and sclera due to excess bilirubin. Document the degree of jaundice and where it is most prominent.
Mottling
Irregular blotchy red/blue patches indicating poor peripheral perfusion. Note location and extent of any mottled areas.
Vitiligo
Patchy loss of skin pigment causing irregular white spots or patches. Document locations and pattern of vitiliginous areas.
Purpura
Red/purple discoloration caused by bleeding under the skin. May occur in spots (petechiae), bruises (ecchymoses), or large areas (ecchymosis). Note characteristics and location of purpuric areas.
Melasma
Hyperpigmentation causing tan or brown patches often on the face. Specify locations of melasma and any precipitating factors.
Using Comparative Descriptions
Skin color changes can also be described in comparison to the patient’s normal skin tone or to standard colors:
- Lighter/darker than normal
- Yellowish discoloration
- Bluish cast
- Bronze coloring
- Salmon-colored rash
However, subjective colors like “flushed” or “pale” should be avoided. Comparisons are most useful when also paired with descriptions of the locations, boundaries, shape, and extent.
Documenting Skin Color Changes Over Time
Ongoing assessment should note any progression, improvement, or worsening of abnormal skin colors:
- Cyanosis spreading from extremities to trunk
- Jaundice improving but still visible in sclera
- Erythema decreasing in size and intensity
- Purpura evolving from petechiae to ecchymosis
Careful documentation provides valuable information about disease progression and response to treatment. Note the time course of skin color variations.
Conclusion
Clear, objective documentation of skin color is a key component of nursing assessment. Utilizing standardized terminology, validated color scales, and comparative descriptions allows nurses to paint an accurate clinical picture. Carefully noting any skin color changes, their locations, time course, and progression provides crucial health information and supports prompt intervention when required. With observational skills and a descriptive approach, nurses can provide optimal skin assessment.
