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ULY CLINIC

ULY CLINIC

18 Septemba 2025, 12:15:48

Decreased skin turgor

Decreased skin turgor
Decreased skin turgor
Decreased skin turgor

Skin turgor refers to the skin’s elasticity, which reflects its hydration status and the integrity of the dermal and subcutaneous tissues. Decreased skin turgor occurs when the skin takes longer than normal to return to its baseline after being pinched or stretched, commonly “holding” for up to 30 seconds. This is a hallmark of dehydration or volume depletion, although it may also be a normal finding in elderly patients or individuals with rapid weight loss.


Pathophysiology

  • Fluid loss or depletion shifts interstitial fluid into the vascular compartment to maintain circulating blood volume, leaving the dermis slack.

  • Dermal elasticity diminishes due to decreased collagen hydration and subcutaneous tissue volume.

  • Contributing factors: Gastrointestinal losses (vomiting, diarrhea), renal losses (diuretics, polyuria), febrile illness, burns, or systemic disease affecting fluid balance.

  • Age-related changes: Elderly patients naturally have decreased dermal elasticity, making turgor assessment less reliable.


History and Physical Examination

History

  • Assess fluid and food intake, including recent periods of vomiting, diarrhea, or excessive sweating.

  • Ask about urinary losses, use of diuretics, alcohol intake, or any illness causing fever.

  • Inquire about weight changes and history of chronic illnesses affecting hydration.


Physical Examination

  • Skin turgor test: Pinch a fold of skin over the sternum, hand, or arm in adults; in infants, roll a fold of abdominal skin. Observe time to return to baseline.

  • Oral mucosa: Check for dryness and furrows on the tongue.

  • Axillae: Inspect for dryness.

  • Jugular veins: Evaluate for flatness, suggesting low intravascular volume.

  • Vital signs: Monitor for hypotension, orthostatic changes, and tachycardia.

  • Level of consciousness (LOC): Assess for confusion, lethargy, or obtundation.

  • Urine output: Monitor for oliguria (<30 mL/hour).


Medical causes

Cause

Onset

Key Features

Associated Signs

Pathophysiology

Management

Dehydration

Acute or subacute

Dry, “tenting” skin; thirst; dry mouth and tongue

Orthostatic hypotension, tachycardia, oliguria, fatigue

Loss of total body water → interstitial fluid depletion

Oral/IV fluids, monitor vitals and urine output, correct electrolytes

Cholera

Acute

Sudden watery diarrhea and vomiting; decreased skin turgor

Muscle cramps, weakness, oliguria, hypotension, tachycardia

Massive fluid and electrolyte loss

Rapid IV fluid replacement (Ringer’s lactate), electrolyte correction, antibiotics if indicated

Volume depletion from other causes

Acute or chronic

“Tenting” skin

Fever, vomiting, diarrhea, excessive diuresis, weight loss

Fluid loss or redistribution

Identify cause, replace fluids, monitor electrolytes, supportive care


Special considerations

  • High-risk groups: Infants, young children, elderly patients, obese individuals, or patients with rapid weight loss.

  • Skin care: Turn patients every 2 hours, massage pressure points to prevent breakdown.

  • Monitoring: Daily weight, strict intake/output records, urine output <30 mL/hour, signs of electrolyte imbalance.

  • Elderly patients: Decreased turgor may be physiologic; evaluate additional signs of dehydration.


Patient counseling

  • Emphasize adequate hydration and early recognition of dehydration symptoms.

  • Educate about reporting decreased urine output, dizziness, lethargy, or dry mucous membranes.

  • Explain the importance of monitoring fluid intake during illness or in hot climates.


Pediatric pointers

  • Diarrhea due to gastroenteritis is the most common cause of dehydration in children under 2 years.

  • Assess for other dehydration signs: sunken eyes, irritability, lethargy, poor feeding, and reduced urine output.

  • Prompt oral rehydration therapy (ORT) is essential for mild to moderate dehydration; severe cases require IV fluids.


Geriatric pointers

  • Skin elasticity naturally decreases with age; turgor alone is unreliable.

  • Evaluate oral mucosa, axillae, urine output, and blood pressure for more accurate assessment.

  • Elderly patients are prone to rapid fluid loss and complications from dehydration; early intervention is critical.


References

  1. Buttaro TM, Tybulski J, Bailey PP, Sandberg-Cook J. Primary Care: A Collaborative Practice. Mosby Elsevier; 2008.

  2. McCance KL, Huether SE, Brashers VL, Rote NS. Pathophysiology: The Biologic Basis for Disease in Adults and Children. Mosby Elsevier; 2010.

  3. Sommers MS, Brunner LS. Pocket Diseases. F.A. Davis; 2012.

  4. Gennari FJ. Disorders of body water metabolism. N Engl J Med. 1998;339:655–661.

  5. McCance KL, Huether SE. Pathophysiology: The Biologic Basis for Disease in Adults and Children. 8th ed. Elsevier; 2019.

  6. Narins RG, Sherwood LM, et al. Physical Diagnosis Secrets. 3rd ed. Elsevier; 2011.

  7. Wingo CS, et al. Fluid and Electrolyte Disorders in Adults. 3rd ed. McGraw-Hill; 2017.

  8. Goldfrank LR, et al. Goldfrank’s Toxicologic Emergencies. 11th ed. McGraw-Hill; 2019.

  9. Smeltzer SC, Bare BG. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 14th ed. Wolters Kluwer; 2021.

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