Skin Turgor Test

What is a Skin Turgor Test?

A Skin Turgor Test, also known as a skin pinch test, is a simple physical examination used to assess the body's hydration level by examining the skin's elasticity. This test involves gently pinching and lifting the skin, often on the lower arm or abdomen, and observing how quickly it returns to its normal position. In individuals who are well-hydrated, the skin will rapidly snap back to its original position, indicating good skin turgor. Decreased skin turgor, where the skin tenting remains and returns slowly to the normal position, is a sign of dehydration (MedlinePlus Medical Encyclopedia, 2019).

Dehydration occurs when the body loses more fluids than it takes in. Based on the percentage of body weight lost, it can be classified into mild, moderate, or severe levels. Mild dehydration reflects a 1-2% loss of body weight, moderate dehydration a 3-5% loss, and severe dehydration greater than 6%. Symptoms of dehydration often include dry skin, dark yellow urine, dizziness, and fatigue.

However, assessing skin turgor alone may not provide a complete picture of hydration status. In a study by Goehring and colleagues (2022), they enumerated factors affecting turgor assessment included dehydration, aging, chronic health conditions, and medications that may reduce skin elasticity. Due to these variables, assessing skin turgor is not the only way to measure hydration status. It must be used with other assessments to form a comprehensive evaluation.

The Skin Turgor Test's simplicity and non-invasive nature make it a commonly used tool in various clinical scenarios. However, considering the clinical context and patient history, its findings should always be interpreted carefully.

How to use our Skin Turgor Test template

Our Skin Turgor Test template includes detailed instructions for conducting the test and fields to record results. Healthcare professionals can use it to document findings and create a personalized care plan.

Step 1: Access the template

Use the “Use template” button to open the template within the Carepatron app, where you can customize and share it. Alternatively, click “Download” to get a printable version.

Step 2: Assess the patient

Select a site for the test, such as the lower arm or abdomen. Grasp a small section of skin and pull upwards to create a "tent." Release the skin after a few seconds and observe how quickly it returns to normal.

Step 3: Record the results

Document whether the skin returns to normal quickly (good skin turgor) or remains tented (poor skin turgor). Use the provided fields to note the response and any additional observations.

Step 4: Discuss the results with the patient

Explain what the test results indicate about their hydration level. If applicable, educate the patient on maintaining adequate hydration and recognizing the early signs of dehydration.

Treatment for skin turgor

Treating poor skin turgor, which is often a sign of dehydration, primarily involves addressing the underlying cause of the dehydration. Here's a comprehensive approach to improving skin turgor through rehydration and other supportive measures:

Increase fluid intake

The first and most straightforward step in treating reduced skin turgor is to increase fluid intake since severe fluid loss and inadequate fluid intake can directly cause dehydration. This can be done by drinking more water, using oral rehydration solutions, or drinking other hydrating fluids like clear broths and sports drinks with electrolytes. For mild dehydration, encouraging regular sips of water throughout the day can be effective.

Intravenous fluids

In cases of severe dehydration or when oral intake is not possible or sufficient, intravenous (IV) fluids may be administered. This is a common practice in emergency medicine and hospital settings. IV rehydration quickly restores the necessary fluid and electrolyte balance, improving skin turgor and overall hydration.

Monitoring fluid intake and output

It's important to monitor both the amount of fluid intake and urine output. This helps assess whether the body receives enough fluids and responds to the treatment. Regular monitoring is especially crucial for vulnerable populations such as the elderly, infants, and people with chronic illnesses.

Address underlying causes

If the poor skin turgor is due to underlying conditions such as diarrhea, vomiting, or excessive sweating (often due to heat illnesses or strenuous physical activity), these conditions should be treated alongside rehydration. For instance, antiemetics can be used for vomiting, and antidiarrheal medications may be considered for diarrhea.

Adjust diet

Incorporating foods with high water content, like fruits and vegetables, can help maintain hydration. During the rehydration process, it's also essential to avoid dehydrating substances like caffeine and alcohol.

Control the environment

In cases where environmental factors like extreme heat contribute to dehydration, moving to a cooler environment and reducing physical exertion can be helpful.

Improve skin care

Educate patients on using hydrating lotions or moisturizers to address dryness or flakiness caused by dehydration. Healthcare professionals can apply appropriate moisturizers during clinical visits, teaching patients to maintain healthy skin externally as they rehydrate internally.

Treating poor skin turgor effectively means addressing the immediate fluid deficit and implementing strategies to prevent future episodes of dehydration. Education on adequate fluid intake, recognizing early signs of dehydration, and understanding individual hydration needs are key to long-term management.

Challenges in older adults

In conducting Skin Turgor Tests in older adults, there are specific challenges that need to be considered:

• Decreased skin elasticity: As people age, their skin naturally loses elasticity. Thus, when you measure skin turgor via the pinch test, it is less reliable, as even well-hydrated older adults may have slower skin recoil. This is also affected by skin thickness.
• Hydration status: Older adults are more prone to dehydration due to reduced kidney function, less acute thirst perception, and difficulty accessing or consuming fluids. However, interpreting skin turgor in this group can be challenging due to the changes in skin elasticity above.
• Chronic conditions: Many older adults have chronic health conditions, such as diabetes or heart failure, which can affect their hydration status and skin turgor. Medications for these conditions may also impact fluid balance. Additionally, skin turgor can be affected by connective tissue disorders. Patients with conditions like Ehlers-Danlos syndrome or Marfan syndrome may have altered skin elasticity, which can complicate the interpretation of Skin Turgor Tests.
• Cognitive impairment: Cognitive issues like dementia can affect an older adult's ability to communicate discomfort or understand the importance of adequate fluid intake, complicating the assessment and management of hydration.

References

Goehring, M., Farran, J., Ingles-Laughlin, C., Benedista-Seelman, S., & Williams, B. (2022). Measures of skin turgor in humans: A systematic review of the literature. Wound Management & Prevention, 68(4), 14–24. https://doi.org/10.25270/wmp.2022.4.1424

MedlinePlus Medical Encyclopedia. (2019). Skin turgor. National Library of Medicine. https://medlineplus.gov/ency/article/003281.htm