What does skin tenting indicate?

Skin Tenting as an Indicator of Dehydration

Skin tenting indicates dehydration, which can be assessed by pinching and gently lifting the skin over the shoulder blades (skin turgor test). If the tent remains or is slow to resolve after release, the patient is dehydrated. 1

Assessment of Skin Tenting

Skin tenting is a clinical sign evaluated through the skin turgor test:

• Technique: Pinch and gently lift the skin over the shoulder blades
• Normal response: Skin quickly returns to its original shape
• Abnormal response: Skin remains tented or is slow to resolve
• Severity correlation: The longer the skin remains tented, the more severe the dehydration 1

Clinical Significance

Skin tenting is a reliable indicator of hydration status with important clinical implications:

1. Dehydration assessment: Prolonged skin tenting indicates decreased skin elasticity due to loss of interstitial fluid

2. Severity estimation:

   • Mild dehydration (3-5%): Slightly delayed return of skin
   • Moderate dehydration (6-9%): Obvious delay in skin return
   • Severe dehydration (≥10%): Significant tenting with very slow return 2

3. Additional dehydration signs to evaluate alongside skin tenting:

   • Dry mucous membranes
   • Sunken eyes (in severe cases)
   • Altered mental status (in severe dehydration)
   • Decreased urine output 1

Clinical Applications

Skin tenting assessment is particularly valuable in:

1. Acute illness evaluation: Especially in patients with diarrhea, vomiting, or decreased oral intake

2. Sepsis assessment: Skin tenting is part of the initial evaluation of potentially septic patients 1

3. Monitoring fluid therapy response: Serial assessments can track improvement in hydration status

4. Resource-limited settings: Provides valuable clinical information when laboratory tests are unavailable

Limitations and Considerations

Several factors can affect skin turgor assessment:

• Age: Elderly patients may have decreased skin elasticity due to age-related changes, potentially causing false-positive skin tenting 1

• Nutritional status: Severe malnutrition or cachexia can affect skin elasticity

• Skin conditions: Certain dermatological conditions may alter skin elasticity independent of hydration status

• Location: The skin over the shoulder blades provides the most reliable assessment site in adults 1

Management Implications

When significant skin tenting is observed:

1. Fluid resuscitation: Initiate appropriate fluid therapy based on the degree of dehydration

2. Route of administration:

   • Mild-moderate dehydration: Oral rehydration if tolerated
   • Severe dehydration: Intravenous fluid resuscitation 1

3. Monitoring: Regularly reassess skin turgor to evaluate response to treatment

4. Addressing underlying cause: Identify and treat the condition causing dehydration

Skin tenting remains one of the most accessible and practical clinical signs for evaluating hydration status, particularly valuable in settings where laboratory assessment is limited or delayed.