Assessment and Planing Care

This section will outline a systematic approach to assessment, introducing key concepts, their application and both physical and psychological assessment tools. Key principles and issues regarding the planning of care and relevant factors will be summarised. Details of the assessment process related to specific conditions in the relevant condition related sections are provided. An overview will be given of common dermatological interventions and related psychological and educational interventions, although the detail will be discussed and signposted to the relevant sections elsewhere. Finally, some issues of evaluation and the use of evaluative strategies are highlighted.

An effective plan of care requires careful assessment, the related planning of interventions and a systematic evaluation of its consequences. As the largest organ of the body, and the most visual, the skin is highly accessible to assessment, although the process is complex. The challenge of assessing abnormal changes in the skin is the sheer number of variation that may occur in site, colour, texture or surface features and the type of lesions that may be present. This section builds on the previous one on skin biology. Effective planning of care requires an understanding of normal structure and function, its disruption by disease processes and the influence of psychosocial factors. The International Classification of Disease (ICD-10) index of dermatological diagnoses conveys the considerable and complex range of dermatological conditions, listing several hundred (www.who.int/classifications/icd/en/); however, the British Association of Dermatologists Diagnostic Index has over 4,000 preferred terms, with highly differentiated dermatological diagnoses. Many of these are rare in nature. The most common conditions fall into nine categories: skin cancer, atopic eczema, contact dermatitis and other eczemas, psoriasis, acne, blistering conditions, viral warts, other infective disorders, benign tumours and vascular lesions, leg ulceration (Williams, 1997). Indeed, a person may not have a skin disease per se, but a problem such as dryness (xerosis), which can be both uncomfortable and disruptive, leads to other problems with the skin barrier.

The purpose of assessment is to determine the nature of the clinical problem, its relative priority and the possible need for referral, given the nature and complexity of the person’s condition. If the clinician does not have a diagnostic role then skill is required to accurately describe any changes observed that aid effective communication with clinical colleagues, and in particular to ensure appropriate referral. It is necessary to approach skin assessment in a systematic and holistic way, reviewing not only physical changes but also any psychological and social impact on the person and their family. This must also embrace a review of the impact on the quality of life of the person and their family.


Assessment is not a one-off activity but rather an ongoing process, which involves monitoring changes in the patient’s condition, their response to such changes and those related to treatment effects that are either therapeutic or adverse in nature.