What is the appearance of skin tenting?

From the Guidelines

Skin tenting is characterized by a visible delay in skin returning to its normal position after being pinched, forming a "tent-like" appearance, which is a reliable clinical sign of dehydration, particularly in younger patients. When assessing skin tenting, healthcare providers typically pinch the skin on the back of the hand, forearm, or over the sternum, and observe how quickly it returns to its normal position. According to the study by the Centers for Disease Control and Prevention 1, signs and symptoms of dehydration, including skin tenting, are crucial in guiding therapy, especially in infants with acute diarrhea who are more prone to dehydration. The study notes that moderate dehydration (6%-9% fluid deficit) is associated with loss of skin turgor, tenting of skin when pinched, and dry mucous membranes. Some key points to consider when assessing skin tenting include:

• The severity of dehydration can be estimated by the duration of skin tenting, with more severe dehydration resulting in longer skin retraction times
• Skin tenting is a more reliable clinical sign in younger patients, as elderly individuals may have decreased skin elasticity due to age-related changes
• Healthcare providers should assess skin tenting as part of a physical examination when evaluating a patient's hydration status, alongside other signs like dry mucous membranes, decreased urine output, and thirst, as noted in the study 1. It is essential to consider these factors when evaluating skin tenting to accurately assess a patient's hydration status and provide appropriate treatment.

From the Research

Skin Tenting Appearance

The appearance of skin tenting can be described as follows:

• Skin tenting is a clinical feature where the skin appears to be pulled or dimpled, often due to underlying tissue involvement or fluid loss 2, 3
• In breast cancer, skin tethering can be elicited by pushing the lump in one direction, causing skin dimpling that was not otherwise evident 2
• In displaced midshaft clavicle fractures, skin tenting can appear as a bulge or indentation in the skin, often associated with lower BMI and fracture shortening 3
• Skin tenting can also be a sign of dehydration, where the skin appears to be loose and saggy, and can be measured by assessing the duration of skin tenting in the lateral neck region 4

Factors Associated with Skin Tenting

Several factors can contribute to the appearance of skin tenting, including:

• Tumor involvement of the ligaments of Cooper in breast cancer 2
• Fracture shortening and lower BMI in displaced midshaft clavicle fractures 3
• Dehydration and fluid loss in calves and cattle 4
• Degradation of elastic fibers and loss of skin elasticity with advancing age 5