Who is at risk of skin tears?
Intrinsic and extrinsic factors

What factors should we look out for to reduce the risk of skin tears?

Skin tears can be extremely painful and upsetting for patients. Despite the prevalence of skin tears and their impact on a patient’s quality of life, their seriousness is often underestimated. This has frequently resulted in skin tears being underreported and a lack of consistency in their management.[6]

In recent years, The International Skin Tear Advisory Panel (ISTAP) has spearheaded efforts to improve the assessment, classification and management of skin tears. However, performing a risk assessment and implementing an effective prevention strategy remain the most important aspects of skin tear management.

The first step of a risk assessment is identifying which intrinsic and extrinsic factors make a patient more vulnerable to skin tears. 

The structure of our skin changes as we age. These changes make the skin more fragile and less resistant to the effects of friction and shearing forces.

Neonates are also at risk of skin tears due to the immaturity and fragility of the skin. Children’s skin has around 40% less epidermal thickness than adults.[7] The risk is higher in premature infants and those with long-term medical conditions due to the use of medical equipment and invasive medical procedures.

Skin tears are more common in women than in men.[8]

A previous skin tear indicates that a patient’s skin is fragile and predisposed to skin tears.

Certain comorbidities can increase the risk of skin tears. For example, patients with dementia sometimes exhibit restless and agitated behaviour, which can make them more susceptible to injury.

Visual and hearing impairments make it more difficult for patients to perceive physical obstructions (i.e., sharp furniture edges) that can lead to injuries.

Patients that need assistance with daily activities such as dressing, bathing and walking are more likely to experience mechanical trauma and skin tears.

Photoaging is the cumulative damage caused to the skin by exposure to the sun.

Xerosis is the medical term for dry skin. Skin that is extremely dry is more prone to skin tears.

Dehydration can lead to dry, itchy and flaky skin that is more susceptible to damage from mechanical trauma.

Malnutrition can have a negative impact on a patient’s overall health and skin integrity.

Certain medications can affect the skin’s health. Corticosteroids can thin the skin, making it more susceptible to skin tears.[9]

Other drugs can cause drowsiness and slow down reflexes. This can lead to falls or bumps that may result in the development of a wound.

The removal of strong adhesives can inflict trauma on fragile skin.

Poor handling of medical equipment (i.e., wheelchairs) can lead to injuries and wounds.

Blood draws puncture the skin, creating a small wound, which can cause a skin tear.

Smoking decreases the supply of oxygen to the skin and breaks down collagen. This can adversely affect the integrity of the skin and its wound healing abilities.

Trip hazards (i.e., electricity cables) can lead to falls resulting in wounds.

Bumping into sharp corners or furniture can cause the skin to split and develop a skin tear.

Skin cleansers that are not pH-balanced or bathing too often can strip the skin of its natural oils and moisture and lead to dryness.

Jewellery can scratch or pinch the skin, which can lead to a skin tear.