The 3 Skin Signs for Evaluating Patients

One of the first things medical students are taught is to look at their patient's skin. That might seem to be a little basic, but you can learn a whole lot simply by paying attention to a person's skin color and moisture. These are the two things that you are likely to see as a person enters the room.

Skin temperature is also important. The triad—skin color, moisture, and temperature—is collectively known as the skin signs. In most emergency situations, the skin is one of the first organs to react to a dangerous condition.

Female doctor checking patient's neck
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Skin Color

Skin comes in a variety of hues. It can be olive or rosy. It can be extremely dark or almost completely white. These color variations come from hereditary pigmentation in the skin (melanin) and have absolutely nothing to do with medical conditions.

It's not the pigment of the skin that doctors are concerned about but rather the color under it. This "undercoat" comes from blood circulating within tiny blood vessels beneath the surface of the skin called capillaries. Blood perfuses these channels one red blood cell at a time.

Red blood cells contain a substance called hemoglobin that binds to oxygen. Hemoglobin is primarily made of iron. The exposure of oxygen to blood iron leads to a chemical process called oxidation that is no different than what occurs in nature.

In nature, the oxidation of iron leads to red rust. In the body, the oxidation of hemoglobin turns the blood a bright red—a color that is considered normal and healthy.

By contrast, having a normal volume of red blood cells but not enough oxygen can turn the cells a purplish-red or even blue. If the volume of red blood cells is low, there will be a loss of the characteristic redness as the blood circulates through vessels.

These changes can often be seen in a person's physical appearance. Among some of the tell-tale signs:

  • Purple or bluish skin is a sign of cyanosis. This typically indicates low blood oxygen. If this is accompanied by dyspnea (shortness of breath) or bradypnea (slow respiration), the person is likely experiencing hypoxia (lack of oxygen).
  • Pale skin can be a sign of anemia (low blood cells), dehydration, or shock. It means the body either doesn't have enough red blood cells or is not allowing blood to flow all the way to the skin. To conserve it, the body will redirect blood from the surface to the core.
  • Flushed skin indicates too much blood flow to the surface of the skin. This may be an indication of hypertension (high blood pressure). Heat overexposure and fever can cause the same as the body re-routes the blood to the surface to release heat.

It doesn't matter what the pigmentation is. Very dark-skinned people look just as pale when they don't have a lot of blood flow to the skin's surface. And those with extremely light skin can be a lot paler than you might think possible when they're sick.

Your brain will recognize it, even if you don't at first. How many times have you seen a coworker on a bad day and remarked how ill he or she looked? More often than not, it's the color of the blood flowing—or not flowing—under the surface that your brain is noticing.

Skin Moisture

Next to skin color, skin moisture is an important clinical sign. This sign is pretty simple to identify, at least in the extremes. Overhydrated skin can look swollen, wrinkly, or whitish in color. Overly dry skin is noticed especially when it's scaly or feels "saggy" on touch.

Supple, non-scaly skin is preferred when considering skin moisture and texture. When the skin moisture level is abnormal, it can lead to the following clinical signs:

  • Extremely dry skin with poor turgor (elasticity) is an indicator of poor blood flow. In such cases, the skin will fail to snap back to its original shape. Causes of poor turgor include dehydration, severe diarrhea, diabetes, and heat exhaustion.
  • Overly sweaty skin is called diaphoresis. Sweating for a workout is fine, but the skin is typically said to be diaphoretic if it is wet for no apparent reason. The other nickname for diaphoresis is cold sweats. Diabetes, shock, infections, and heart attack can manifest with cold sweat.
  • Whitish, wrinkly skin is a sign of skin maceration, typically caused by oversoaking the skin. While this will normally resolve once the skin dries out, it may also be a common consequence of chronic urinary incontinence.

Skin Temperature

The final skin sign is temperature. This one requires human touch. It's very hard to assess skin temperature by looking at a person. This skin sign is pretty subjective and could be misleading in not placed in its proper clinical context.

Abnormal temperature is a skin sign when perceived by comparison (for instance, when your hands are cold but everything else feels warm).

For instance, it is not a good sign if one leg is hot to the touch and the other is not. Even more alarming is if the hot leg is also swollen and red. This could be a sign of deep vein thrombosis (DVT) or cellulitis.

Skin temperature can indicate different things:

  • Hot skin is an indicator of heavy blood flow to the surface. In some cases, it can indicate a localized infection if the sign is limited to a specific area (such as with MRSA) or indicate fever or a systemic infection if the entire body is hot.
  • Cool skin indicates poor circulation. Causes include obesity, heart failure, hypothermia, diabetes, hypothyroidism (low thyroid function), and sepsis.

A Word From Verywell

Doctors, nurses, and other healthcare professionals are taught to recognize when a person is very sick at first glance. Skin signs are key to this.

For those who are not trained to recognize these signs, gut instinct may be the best thing to rely on. Rather than trying to figure out why your skin may be hot, abnormally dry, or discolored, call your doctor and schedule an appointment.

If your gut tells you that something is really wrong, don't delay. Go to your nearest emergency room, particularly if symptoms are developing rapidly.

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  1. Adeyinka A, Kondamudi NP. Cyanosis. In: StatPearls [Internet]. Updated February 26, 2021.

  2. Everett JS, Budescu M, Sommers MS. Making sense of skin color in clinical care. Clin Nurs Res. 2012 Nov;21(4):495-516. doi:10.1177/1054773812446510

  3. De Vries Feyens C, de Jager CPC. Images in clinical medicine: decreased skin turgor. N Engl J Med. 2011 Jan 27;364(4):e6. doi:10.1056/NEJMicm1005144

  4. Brackenrich J, Fagg C. Hyperhidrosis. In: StatPearls [Internet]. Updated September 11, 2020.

  5. Shigeta YI, Sugama J, Sanada H, et al. Physiological and appearance characteristics of skin maceration in elderly women with incontinence. J Wound Care. 2014 Jan;23(1):18-9:22-3. doi:10.12968/jowc.2014.23.1.18

  6. Norazirah MN, Khor IS, Adawiyah J, Tamil AM, Azmawati MN. The risk factors of lower limb cellulitis: a case-control study in a tertiary centre. Malays Fam Physician. 2020;15(1):23-9.

  7. Owens KN, Goldstein C. EMS clinical diagnosis without the use of a thermometer. In: StatPearls [Internet]. Updated September 23, 2020.

  8. Yousef H, Ahangar ER, Varacallo. Physiology, thermal regulation. In: StatPearls [Internet]. Updated June 19, 2020.