Skin turgor

Definition

Skin turgor is the skin's ability to change shape and return to normal (elasticity).

Alternative Names

Doughy skin; Poor skin turgor; Good skin turgor; Decreased skin turgor

Considerations

Skin turgor is a sign commonly used by health care workers to assess the degree of fluid loss or dehydration. Fluid loss can occur from common conditions, such as diarrhea or vomiting. Infants and young children with vomiting, diarrhea, and decreased or no fluid intake can rapidly lose a significant amount of fluid. Fever speeds up this process.

To determine skin turgor, the health care provider grasps the skin on the back of the hand, lower arm, or abdomen between two fingers so that it is tented up. The skin is held for a few seconds then released.

Skin with normal turgor snaps rapidly back to its normal position. Skin with decreased turgor remains elevated and returns slowly to its normal position.

Decreased skin turgor is a late sign in dehydration. It occurs with moderate to severe dehydration. Fluid loss of 5% of the body weight is considered mild dehydration, 10% is moderate, and 15% or more is severe dehydration.

Note: Edema (a buildup of fluid in the tissues that causes swelling) causes the skin to be extremely difficult to pinch up.

Common Causes

• Decreased fluid intake
• Dehydration
• Diarrhea
• Diabetes
• Extreme weight loss
• Heat stroke (excessive sweating without enough fluid intake)
• Vomiting

Connective tissue disorders, such as scleroderma and Ehlers-Danlos syndrome, can also affect the elasticity of the skin. This does not have to do with fluids, but is a change in the elastic properties of the skin tissue.

Home Care

A quick check of skin turgor by pinching the skin over the back of the hand, on the abdomen, or over the front of the chest under the collarbone is a good way to check for dehydration at home.

Mild dehydration will cause the skin to be slightly slow in its return to normal. To rehydrate, drink more fluids -- particularly water.

If turgor is severe, indicating moderate or severe dehydration, see your health care provider immediately.

Call your health care provider if

• Poor skin turgor occurs with vomiting, diarrhea, or fever.
• During a check of skin turgor the skin is very slow to return to normal, or the skin "tents" up. This can indicate dehydration that is severe enough to require immediate treatment.
• You have reduced skin turgor and are unable to increase your intake of fluids (for example, because of vomiting).

What to expect at your health care provider's office

The health care provider will perform a physical exam and ask questions about your medical history, including:

• How long have you had symptoms?
• What other symptoms came before the change in skin turgor (vomiting, diarrhea, others)?
• What have you done to try to treat the condition?
  • Did it make it better?
  • Is it getting worse?
• What other symptoms do you have (such as dry lips, decreased urine output, and decreased tearing)?

Tests that may be performed:

• Blood chemistry (such as a chem-20)
• CBC
• Urinalysis

Intravenous fluids may be necessary for severe dehydration. You may need medications to treat other conditions that affect skin turgor and elasticity.

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References

Greenbaum L. Deficit therapy. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 54.

Gorgas DL, Barry JD. Vital signs measurement. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 1.