Skin Turgor Test

What is Skin Turgor?

The term turgor has a Latin origin. Turgor means the normal fullness state. Skin turgor is associated with elasticity or skin tension that occurs when you pinch your skin and after its release, it recoils. The skin turgor test can be used by a nurse or doctor at the time of a physical examination to look for any possible signs of dehydration. The skin’s ability to be able to get pulled from the original position is known as skin mobility. So the kind of skin which has decreased mobility usually has increased turgor and vice versa.

Skin Turgor Test – Source Youtube.com

Skin Turgor Test – Common Locations

The below data shows the locations for skin turgor test on your body. From top to bottom of this list, the reliability decreases.

1. Glabella: this is the forehead’s most prominent region. It is the area between the two eyebrows. Below your clavicle and over your sternum in the upper chest also comes in this category. The test done here has minimum effect of skin wrinkles caused by the age.
2. Calf (back side), forearm (the outer side) and thighs (the inner side) come second in the list. The advantage of doing the test at these places is that it causes the minimum discomfort in a person.
3. Umbilicus is the area at the abdomen. The test can be done here in case of small children or infants.
4. The region between the index finger and the thumb which falls at the back of the hand. Now even though the test done here is not reliable and is also easily affected by wrinkling caused due to age, it becomes convenient to do it here in case of self-tests.

Some of the most unreliable sites for performing a skin turgor test are finger knuckles, neck, buttocks, face and back. In case of the neck, the skin over there is saggy and it becomes redundant. For finger knuckles, even if the body is hydrated, the skin turgor will be poor. For the buttocks, face and back region, in case of the severe dehydration, the skin turgor would have decreased.

Different terms used at hospitals to describe different types of skin turgor tests:

For the documentation of medical charts, various terms are used for describing skin turgor tests. Here are some of them:

• Sluggish versus brisk. In this case, brisk means resilient.
• Non elastic versus elastic
• Poor versus good. In this case, poor means decreased or reduced.
• Prolonged versus normal. In this case, prolonged means delayed.
• Doughy or tenting, that is, if it is prolonged by several minutes or several seconds.
• WNL. It stands for within normal limits. It is important to note here that as such, there is no normal range, but immediate recoil can be considered normal.

This is how a typical documentation of a skin turgor test reads: “skin recoil 4 seconds at the clavicle.” Any other details of the classification or any other skin turgor rating or value do not exist.

• Skin Turgor Test (Normal): A normal skin turgor test means that once pinched, the released skin recoils almost immediately, it, in not more than 0.5 seconds. However, you should also know that if the skin does recoil immediately, it does not necessarily mean that the person has good hydration. For example, in case of obese people, they are highly like to have a condition called scleroderma, which means they have a thick skin. Hence, they will have a skin turgor test which will be normal, but they are also highly likely to be dehydrated.
• Skin Turgor Test (Poor): A poor skin turgor test is when the recoiling of the skin gets delayed for any particular amount of seconds. However, here also it is important to note that a decreased or a poor skin turgor test does not mean that necessarily mean that the person is dehydrated. Older people with wrinkled skin often have poor skin turgor tests but they can be properly hydrated.

The mechanism and causes of poor and increased skin turgor test

A normal skin turgor test where there is elasticity and fullness can be associated with the presence of elastic fibers and water in your skin. So now the decrease in elasticity of the skin can be there due to the dehydration of the entire body or it could also be due to skin dehydration which is isolated. Such condition is commonly found in the older people.

Here are some of the most common causes for a poor skin turgor test:

• Dehydration: this happens to be the most common cause for a poor skin turgor test.
• Wrinkled skin: Wrinkled skin in people is caused mainly due to ageing or smoking.
• Quick weight lost: In the cases of women who have delivered a baby and hence have a decreased value of abdomen. This happens due to the presence of redundant skin on abdominal wall.
• Malnutrition: The deficiency of certain vitamins like E, selenium, A or C which is common for people who have chronic alcoholism, anorexia nervosa or the people who have had a prolonged starvation.
• Kidney failure (end stage): in case of people who are on peritoneal dialysis or on hemodialysis, they tend to have rough, dry skin or even xerosis.
• Loose joints, or in case of Cutis laxa where the skin happens to hang in folds: This kind of a condition could be either inherited or it can also be there due to some connective tissue’s disease.

Now that we have seen the causes of poor skin turgor test, let’s take a look at the causes of an increased skin turgor test, which technically means a decrease in the skin mobility:

• Obesity: The skin becomes thicker due to an accumulation of fat on the skin.
• Kidney failure (severe): the severe failure of kidney results in a generalized edema or anasarca. Due to this, there is water retention.
• Septic shock: Because of a septic shock, fluids escape from the body vessels.
• Ehlers-Danlos syndrome, Systemic sclerosis or scleroderma and Sjögren’s syndrome: all of these can be associated with the skin’s fibrous connective tissue’s overgrowth.

For the upper body including the face, the treatment is done with steroids. For lower legs, symmetrically, Pitting edema is caused due to sitting or standing for a long time. The other reasons can be menstruation, kidney failure, pregnancy, hyponatremia accompanied by water intoxication, nephrotic syndrome or heart failure (chronic). This condition can be signified by the fact that when skin is pressed over your shinbone with the help of the thumb, it may remain depressed for some seconds. Nonpitting edema can be caused due to myxedema or hypothyroidism. This signifies pretibial edema. For lower legs, asymmetrically, it can be caused by several reasons – pelvic cavity tumors, varices (insufficiency for chronic venous), lymphoma, thrombosis of deep veins, and lymph flow obstruction in case of elephantiasis. For Ascites in abdomen in case of liver cirrhosis, it can be caused due to abdominal distension.

The relation between Skin Turgor and dehydration

In most of the cases, poor skin turgor test would mean a relative late dehydration sign. In severe or even moderate dehydration cases, it can be easily observed. This, though happens when there is more 3% loss in body weight. Here are some common signs, symptoms and causes of dehydration which a doctor can use to diagnose it:

• When we say causes, there could be many. Some of the most common ones include excessive sweating, not drinking ample amount of water, vomiting, diarrhea, hyperventilation or polyuria (excessive urination). Polyuria is common for patients of diabetes mellitus.
• Here are some common signs which can help you decide if you have dehydration – sudden body weight loss, excessive thirst or a poor skin turgor.
• The common symptoms of dehydration are dark urine, body weight loss, thirst, fatigue or less urination.

There are some metabolic disorders which can be associated to dehydration and eventually a poor skin turgor. That said, it does not mean that all metabolic disorders can affect the skin turgor. Here are some which do:

• Hyperglycemia in case of diabetes mellitus which is untreated.
• Hypernatremia
• Hyponatremia  with Hhyperkalemia with in case of adrenal insufficiency, known as hypoaldosteronism.

Skin Turgor  Diagnosis

There are several reasons for a poor skin turgor, as discussed above. Let’s take a look at some of them and understand how the signs for each can affect the skin, show symptoms and what the kinds of circumstances under which these happen are.

• Heat stroke: When you have a heat stroke, your skin can become warm, dry or flushed. The body temperature can drop below 40°C or 104 °F. This happens due to insufficient amount of water intake and extremely hot weather. This means that it’s important to keep hydrated especially when the weather is hot.

• Severe dehydration: in this case, the skin becomes dry, cool and pale. It is often accompanied with diarrhea, excessive sweating and vomiting.
• Hypovolemic shock or Hypovolemia: When this happens, you skin can become moist, pale or cool. The late sign of this is low blood pressure. This can happen in case of severe bleeding.
• Heat exhaustion: when this happens, the skin becomes moist, cool or pale and the body temperature is in the range of 98.6 °F to 104 °F, which means 37 °C to 4 °C. This can again happen when the weather out is extremely hot and you haven’t had enough water to drink.

For toddlers and infants, skin turgor is usually checked on their abdomen. For small children, the common cause of a poor skin turgor is again diarrhea which causes dehydration in their bodies. Some other signs which suggest the same in case of infants are – sunken eyes and fontanels, a decrease in their body weight, dry mouth mucosa and minimal or delayed refill or capillary post pressing on a nail. In case of elderly, they tend to have wrinkled skin and hence a skin turgor which is reduced. This is due to skin dehydration and not the body dehydration. It is important to remember that these two are different things. An older individual can have a reduced skin turgor and be properly hydrated, or overhydrated or even dehydrated. Hence, to test for dehydration for older people, a skin turgor test is not the most reliable. For the same reason, what can be done is carry out the skin turgor test optimal sites which are not highly affected by wrinkling – between 2 eyebrows on the forehead, inner thighs, over sternum or below clavicle. It goes unsaid that arms are not a proper site to check skin turgor in them. In case of bedridden elders, poor turgor is a potential risk for pressure ulcers.

Skin Turgor Test Video