Skin Turgor Test

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Published: December 17, 2013
Last reviewed: December 9, 2016

What is skin turgor?

Skin turgor [from Latin turgor = fullness] refers to skin tension or elasticity, which gives the skin the ability to return to normal shape after being pulled and released 22. A doctor or a nurse usually checks skin turgor during physical examination to assess the level of dehydration in an individual.

What is skin mobility?

Skin mobility refers to how easily can the skin be pulled from its original position 23. The skin that has increased mobility usually, but not always, has decreased turgor and vice versa.


Skin Turgor Assessment

A doctor or a nurse pinches the patient’s skin at a certain site with the thumb and index finger and releases it and then measures the time in which the skin recoils completely. See the skin turgor test on the hand in Picture 1.

 

Skin Turgor Assessment Forehead Picture

Picture 1. Skin turgor assessment on the forehead (at glabella)
(free image use)

Picture of Skin Turgor Assessment

Picture 2. Skin turgor assessment on the back of the hand
(free image use)

CHART 1. Sites (Locations) for Skin Turgor Test

SITE – FROM MOST TO LEAST RELIABLE COMMENT
Glabella — the most prominent part of the forehead between the eyebrows (Picture 1) 6 At these locations, the skin is least affected by age-related skin wrinkling
Upper chest: over the sternum or below the clavicle
Forearm (outer side; see video below), thigh (inner side) 14 or calf (the back side) 3 Checking at these locations causes least discomfort in a patient
Abdomen, near the umbilicus 12 In infants and small children
Back of the hand between the thumb and index finger (Picture 2) The least reliable, affected by wrinkling, but easily accessible for a quick check
UNRELIABLE SITES
Neck Often contains redundant skin 8
Face, back, buttocks Skin turgor decreased only in severe dehydration
Finger knuckles Poor skin turgor despite good hydration


Video 1: Description of the skin turgor test on the forearm

Explanation of the Results

  • When the skin fold recoils immediately, the skin turgor (tension) is said to be good.
  • Skin recoil delayed for less than 2 seconds is described as poor skin turgor, which suggests moderate dehydration.
  • Skin recoil delayed for more than 2 seconds speaks for severe dehydration.
  • Skin fold persisting for several seconds or even minutes is described as tenting.
  • References 1,3.

A Measure of Skin Turgor in Medical Documentation Charts

In different hospitals doctors and nurses may use different terms to describe skin turgor “types:”

  • Elastic or non-elastic (inelastic)
  • WNL — Within Normal Limits (there is no actual “normal range,” so only immediate recoil is normal)
  • Good or poor (bad, loose, reduced, decreased)
  • Brisk (resilient) or sluggish
  • Normal or prolonged (delayed) for 2+, 3+, 4+…seconds
  • Tenting, also described as moist/doughy/boggy if prolonged for several seconds
  • An example of documented skin turgor test: “Skin recoil 3 seconds at clavicle”

No more detailed classification or rating of skin turgor values exists.

Normal Skin Turgor

Skin turgor is considered normal when the skin after being pinched and released recoils almost instantly (in milliseconds). Note that immediate skin recoil does not always mean good hydration: obese people, those with scleroderma or certain other conditions can have increased skin turgor, but can still be dehydrated (see Chart 3).

Poor Skin Turgor

Skin turgor is considered poor when the skin recoil is delayed for any amount of time, even for a half of a second. Note that decreased skin turgor does not always mean dehydration: older people and others with wrinkled skin have poor skin turgor but can still be well hydrated (see Chart 2). In general, old people are no more dehydrated than younger ones.

Mechanism

Normal skin turgor (fullness and elasticity) is maintained by presence of water in the skin cells and between them and by elastic fibers in the skin. In both overall body dehydration and in “isolated” skin dehydration, such as in elderly, there is less water in the skin, what decreases skin fullness and hence its elasticity.

Chart 2. Causes of Poor Skin Turgor

CAUSES of GENERALIZED poor skin turgor COMMENTS
Dehydration Most common cause
Wrinkled skin caused by age, smoking 20, premature ageing (progeria)
Quick loss of weight 20 Redundant skin
Decreased abdominal volume in women after delivery Poor skin turgor on the abdominal wall
MalnutritionDeficiency of vitamin A, C or E, and selenium 25 Common in chronic alcoholism, prolonged starvation, anorexia nervosa
End-stage kidney failure in individuals on hemodialysis or peritoneal dialysis 4 Dry, rough skin or xerosis
Cutis laxa with skin hanging in folds; loose joints Inherited or acquired connective tissue disease
CAUSES of LOCALIZED poor skin turgor
Anetoderma — 1-2 cm big button-hole like wrinkled depressions or elevations anywhere on the skin: genetic or associated with chickenpox, acne, systemic lupus erythematosus (SLE), Lyme disease, Graves disease, Addison’s disease, HIV/AIDS, syphilis, leprosy
Photoageing changes on the sun-exposed skin
Onhocerciasis (a form of filariasis): thin, itchy skin with red rash on lower back, buttocks and legs In tropics; transmitted by a blackfly

Increased Skin Turgor (Decreased Skin Mobility)

Chart 3. Health Conditions in Which the Skin Can be Hard to Pinch

CAUSES OF DECREASED SKIN MOBILITY and INCREASED TURGOR COMMENTS
ALL OVER (GENERALIZED)
Obesity 21 Thick skin due to increased skin fat
Severe kidney failure resulting in generalized edema (anasarca) Water retention
Severe systemic allergic reaction (anaphylaxis) Escape of fluid from the vessels
Septic shock
Systemic sclerosis (scleroderma), Sjögren’s syndrome, Ehlers Danlos syndrome Overgrowth of the fibrous connective tissue in the skin
LOWER LEGS — SYMMETRICALLY
Pitting Edema 18 When you press the skin over the shinbone with the thumb it remains depressed for few seconds
– Prolonged standing or sitting
– Pregnancy
– Before and during menstruation
– Chronic heart failure
– Kidney failure
– Nephrotic syndrome 11
– Liver cirrhosis
– Water overdose (intoxication) in marathon runners resulting in hyponatremia Edema in hands and feet, nausea, headache, weight gain
Nonpitting edema
– Hypothyroidism or myxedema Pretibial edema
LOWER LEGS — ASYMMETRICALLY
– Varices (chronic venous insufficiency)
– Deep vein thrombosis
– Obstruction of the lymph flow in elephantiasis, lymphoma, tumors in pelvic cavity
ABDOMEN (ASCITES)
– Liver cirrhosis
– Heart failure
– Protein malnutrition (kwashiorkor)
– Hypoproteinemia from other reasons
RANDOM SITES
– Bruise (skin or muscle)
– Insect sting or snake bite
– Hematoma, ganglion cyst or tumor under the skin
– Cellulitis (subcutaneous bacterial infection)
– Gas gangrene (after Clostridium perfringens infection) 19
– Burns
– Allergic reaction (hives)
– Contact dermatitis
– Steroids Swelling of the face and upper body

Dehydration

Poor skin turgor is a late sign of dehydration and can be observed in moderate dehydration, which means > 3-5% loss of body weight due to water loss 1.

Causes, Symptoms and Signs of Dehydration

The diagnosis of dehydration should not be made from the poor skin turgor alone, but from a combination of other signs, symptoms and suspected causes of dehydration:

  • Causes: insufficient drinking, excessive sweating, diarrhea, vomiting, excessive urination or polyuria, for example in diabetes mellitus. Check for more causes.
  • Symptoms: thirst, less urination, dark urine, fatigue, headache
  • Signs: dry mouth, poor skin turgor, sudden loss of body weight. Check for more symptoms and signs.

Metabolic Disorders

  • Hypernatremia is usually associated with severe dehydration and hence poor skin turgor 13,14.
  • Hyperkalemia with hyponatremia and dehydration with poor skin turgor can be present in adrenal insufficiency (hypoaldosteronism) 7.
  • Hyperglycemia in untreated diabetes mellitus can result in excessive urination (polyuria), dehydration and poor skin turgor.

Differential Diagnosis

Chart 4. Poor skin turgor in combination with skin color and other signs

CONDITION WITH POOR SKIN TURGOR OTHER SKIN SIGNS OTHER SYMPTOMS and SIGNS CIRCUMSTANCES
Severe dehydration Pale, cool, dry skin Excessive sweating, diarrhea, vomiting
Heat exhaustion Pale, cool, moist skin Body temperature 98.6-104 °F (37-40 °C) Heat wave, dehydration
Heat stroke Flushed, warm, dry skin Body temperature > 104 °F  (40 °C), severe headache Heat wave, dehydration
Hypovolemia (hypovolemic shock) Pale, cool, moist skin Low blood pressure (late sign) Severe bleeding

Infants and Toddlers

  • Usually checked on the abdomen 2,16
  • The main cause of poor skin turgor in small children is dehydration caused by diarrhea.
  • Other signs of severe dehydration in infants: dry mouth mucosa, sunken fontanels and eyes, decreased body weight, prolonged or minimal capillary refill after pressing upon the nails 1,2

Elderly

  • Many older adults have permanently wrinkled skin due to reduced skin turgor because of skin dehydration, which is NOT the same as overall body dehydration. An older person with reduced skin turgor can be well hydrated, dehydrated or even overhydrated, so the skin turgor test in elderly may not be a reliable test for dehydration.
  • In elderly, skin turgor can be optimally assessed at sites that are least affected by skin wrinkling: over the sternum, below clavicle, in the forehead between the eyebrows 9 or on the inner thighs 14. Hands and arms are not a good site to check skin turgor in elderly 15.
  • Poor skin turgor is a risk factor for developing pressure ulcers in bedridden elderly individuals 10.

3 Responses to Skin Turgor Test

  1. this was a pretty good article

  2. Sara Herdz says:

    Thank you this article was very helpful to reinforce information received in the past a while ago. This article has more details about it. Thank you for taking the time to do this.

  3. Gail says:

    Good article, especially with pulling the info all into one place since different terms and assessment methods are used by different nurses and other medical personel, and in different facilities.

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