Skin tears and skin tone–supporting better assessment and treatment of skin tears for all individuals

Skin tears pose a significant challenge for both patients and clinicians, as they cause “pain, distress and anxiety” for any patient.¹ Identifying and documenting skin tears accurately is crucial, yet it is well documented that education on skin assessment would benefit from a deeper knowledge of skin tears in patients with dark skin as well as prevention measures and treatment options tailored to these patients’ needs.²

This issue is further complicated by the fact that much of the instructional materials in medical education predominantly feature white skin^3,4 leaving Healthcare Professionals less equipped to assess and treat skin tears in patients with dark skin tones.⁵

Since skin changes in people with dark skin tones are not recognised or documented quickly enough on a global scale,⁵ these patients face unique challenges when it comes to assessing the risk of skin tears.

To ensure timely and appropriate care for all patients, it’s important to raise awareness and implement evidence-based prevention and management strategies for the assessment and treatment of skin tears.⁵

Skin tears are acute wounds resulting from mechanical forces causing the separation of the outer layers of the skin.⁶ As they bear the potential to evolve into complex and chronic wounds, early identification of individuals at risk is crucial to prevent and minimise the incidence of avoidable skin tears.⁷

The estimated annual incidence of skin tears is approximately 1.5 million cases¹ with prevalence varying according to care setting. The highest prevalence is reported in long-term care facilities.⁸ Hard-to-heal wounds, including skin tears, have a significant impact on patients' lives, leading to “prolonged pain, emotional distress, embarrassment, infection, and reduced quality of life”.⁷

Skin tears occur in any age group but primarily affect the elderly: Age-related skin changes lead to elevated skin fragility and are among the documented risk factors.⁹ Other affected groups include neonates, very young children, and those “who are critically and chronically ill”.^4,10

Accurate assessment and diagnosis across all skin tones significantly impact patient healing outcomes, yet there remains a paucity of evidence on the influence of skin tone in wound care.³ Research indicates that individuals with dark skin tones are more frequently diagnosed with advanced-stage pressure ulcers (PUs), largely due to challenges in early identification and assessment.³ It is well-established that patients with dark skin tones often experience poorer health outcomes, and existing tools and educational approaches in healthcare systems fail to adequately address the needs of this population, particularly in wound care. This gap in practice perpetuates health disparities, resulting in suboptimal care.³ Clinicians are encouraged to utilise objective tools, such as the Skin Tone Tool, which helps assess skin changes in a range of tones and mitigates bias.³ Holistic skin assessments, considering variations in skin temperature, texture, and tone, are essential for providing equitable care and preventing skin damage in patients with dark skin tones. The emphasis should be on recognising skin tone diversity and using neutral, professional language in wound care practices to reduce bias and ensure optimal patient outcomes.

To inform clinical decision-making, clinicians should adhere to international best practice guidelines for the prevention and management of skin tears.³ Best practice procedures promote standardisation in care to prevent inadequate assessments, poor documentation, incorrect diagnoses, inefficient treatment pathways, and an increased risk of chronic wounds.¹⁴