Despite seeming like minor injuries, skin tears can be complex wounds with the potential to significantly affect an individual’s health and cause chronic discomfort (LeBlanc 2014).
Skin tears are often misdiagnosed and underreported, and in many cases are preventable (Wounds International 2018).
What are Skin Tears?
Skin tears are acute, traumatic injuries caused by shearing, friction or blunt force wherein the layers of skin are separated. This may be a separation of the epidermis from the dermis (partial thickness) or separation of both the epidermis and dermis from underlying structures (full thickness) (RWV 2018).
Any part of the body can be affected by skin tears, but 70 to 80% occur on the arms and hands (Wounds International 2018).
Generally, skin tears affect those with fragile skin. They are most common in older adults, accounting for nearly 55% of all wounds (LeBlanc 2014; Western Alliance 2018).
Skin tears are more common in women than men, as decreased oestrogen levels (caused by menopause) adversely affect the wound-healing process. Women’s greater life expectancy is also a factor (Western Alliance 2018; Horng et al. 2017).
Why are Older Adults More Susceptible to Skin Tears?
The physiology of skin undergoes several changes with age, causing it to become more fragile and vulnerable to trauma:
The epidermis thins;
The epidermal junction flattens;
There is a loss of collagen, elastin and glycosaminoglycans;
Levels of dermal proteins (which contain moisture) decrease;
The dermis will atrophy and contract;
There is decreased activity of sweat glands and sebaceous glands; and
Blood vessel walls thin and blood supply to the extremities decreases.
(Wounds International 2018; Clothier 2014)
These changes, in tandem with reduced skin regeneration abilities and a weakened protective immune system, mean that an older adult’s skin integrity can be damaged by even a small amount of force (Wounds International 2018).
Risk Factors for Skin Tears
Factors that increase the risk of developing skin tears include:
Age (those over 75 are more at risk);
Gender (females are more at risk);
Previous skin tears;
Reliance on others for personal needs (e.g. bathing);
Sensory or cognitive impairments;
Poor nutrition and hydration; and
Medications that cause skin thinning.
Preventing Skin Tears
Identifying at-risk patients through a holistic skin assessment on admission is crucial in the prevention of skin tears (Wounds International 2018).
The healthcare worker should assess:
The patient’s skin;
The patient’s medical history;
Intrinsic risk factors for vulnerable skin;
Whether the skin is in-tact;
Wound-related risk factors (e.g. eczema, oedema);
Any skin conditions, rashes, itches, pain or other unusual issues;
The patient’s knowledge about the condition of their own skin;
When caring for patients at risk of suffering skin tears, healthcare workers should take the following measures:
Keeping fingernails short;
Not wearing jewellery;
Padding or removing dangerous furniture or devices (e.g. bed rails, wheelchairs);
Covering the skin of vulnerable patients with appropriate clothing, shin guards or retention bandages/stockinettes;
Using products that are pH balanced and have preventative emollients to maintain the patient’s skin integrity;
Reducing the patient’s sun exposure;
Minimising the frequency of the patient’s bathing, ensuring water is not too hot and gently patting their skin dry with a soft towel (instead of rubbing); and
(Wounds International 2018, 2020)
Identifying and Assessing Skin Tears
Correct and prompt identification of skin tears is essential in the effective management of the wound. A thorough examination of the skin tear as well as a holistic patient assessment (see above) should be performed upon presentation (Wounds International 2018).
The following should be documented as part of the skin tear assessment: