Volume 45 Number 2

Welcome to this issue’s editorial. As President of the International Skin Tears Advisory Panel (ISTAP) I am delighted to share my thoughts surrounding skin tears. Skin can be damaged in any health or home care environment, so it is essential that professionals, carers, patients and the general public are aware of how to protect skin and prevent skin tears. ISTAP aims to raise awareness and provide resources and free education activities to improve and enhance knowledge and skills for this specialised and often overlooked area of skin damage. Skin tears are acute wounds that occur across the age range but are generally more common in the older person, are caused by mechanical forces, can lead to pain, reduced mobility, and deterioration of quality of life. However, skin tears are often perceived to be ‘just a skin tear’ leading to a lack of accurate incidence and prevalence data internationally. Strazzieri Pulido et al examined five epidemiological studies, published between 1990 and 2014, in their systematic review highlighting incidence rates ranging from 2% to 92% in long term care facilities.¹ In Australia, Miles et al included 5801 patients in an acute setting exploring skin tears. They identified skin tear prevalence as being between 7.9% and 10.8% with these skin tears representing between 11.9% and 16.7% of all hospital-acquired wounds and was the largest group of wounds in the aged care cohort.²

Standardised approaches to promotion of skin health enhance prevention of skin damage and lead to early recognition of skin tears. Maintenance of skin health is key to preventing skin damage which should include use of skin-friendly, pH balanced products, skin-friendly cleanser, warm water and preventative emollients - traditional soap should not be used. Adequate nutrition and hydration should be maintained. It may be necessary to complete a Malnutrition Universal Screening Tool (MUST) score and maintain a fluid balance chart.  Research recommends application of moisturiser twice daily to maintain skin integrity with creams rather than lotions as creams donate moisture and aid in retention of moisture on the skin surface.³

Consideration must be given to the use of appropriate protective clothing, such as shin guards, long sleeves, long trousers, retention bandages or stockinette to help prevent damage.  Safe moving and handling techniques using moving sheets need to be adopted with families and carers taught these procedures to prevent inadvertent skin damage.  Families, care givers and patients should keep fingernails short to prevent accidental scratching of the skin.

Assessment of the environment is important with professionals and families ensuring the home is safe and free of potential risks to the skin this includes removing any potentially dangerous furniture or equipment, such as bed rails and wheelchairs, making sure there is adequate lighting in the home and encouraging the wearing of footwear that fits correctly, ill-fitting footwear can lead to slips and trips.

Accurate documentation of all interventions and education delivered to families and patients must be completed in accordance with local policies and in a timely manner. When delivering education to patient and carers it is of the upmost importance you are confident, they understand the concepts. You should offer the information verbally, allow ample time for questions and offer written information to support the education given. If the family/carers/patients are able it may be beneficial to refer them to extra information available online and/or to the ISTAP website.  For healthcare professionals there should be local guidance for the maintenance of skin integrity and prevention of skin tears and these must be adhered to. ISTAP have a range of assessment tools that are validated and can be incorporated into clinical practice.

Skin tears are acute wounds that can affect people across the life cycle. Maintenance of skin integrity is paramount in prevention of skin tears. Holloway et al further explain the causes, principles and practice of skin tear management in their article. Prevention of skin tears is the responsibility of all healthcare professionals, carers and patients with education being the lynch pin to achieve this. The ISTAP exists to help enhance education, skills and knowledge for all. Please do not forget that documentation is essential - this allows for a clear and accurate picture of all interventions, advice and education that has been delivered. Please do join ISTAP if you are not already a member, it is free and allows you access to resources and education.

Please also join ISTAP and WCET^® for our joint “Skin Health & Skin Tears: doing the right thing”. A Shared Vision for Evidence-Informed Clinical Practice in celebration of Norma N Gill Day 26th June 2025.

It is very exciting to relay the World Health Organisation has adopted a sentinel resolution on skin diseases entitled “Skin Diseases as a Global Public Health Priority,” that recognises the importance of addressing care deficits in complex skin conditions globally. I encourage you all to review and action the forthcoming Global Plan of Action on skin diseases. (See p 11).

Best Wishes

Karen

Author(s)

Karen Ousey
PhD MA PGDE BA RN
ISTAP President
Emeritus Professor of Skin Integrity, University of Huddersfield, UK

References

1. Strazzieri-Pulido KC, Peres GR, Campanili TC et al (2017) Incidence of skin tears and risk factors: a systematic literature review. Journal of Wound, Ostomy, and Continence Nursing. 44, 1, 29-33. doi: 10.1097/WON.0000000000000288
2. Miles SJ, Fulbrook P, Williams DM. Skin tear prevalence in an Australian acute care hospital: A 10-year analysis. Int Wound J. 2022; 19(6): 1418-1427. doi:10.1111/iwj.13735
3. Carville K, Leslie G, Osseiran-Moisson R, Newall N, Lewin G. The effectiveness of a twice-daily skin-moisturising regimen for reducing the incidence of skin tears. Int Wound J. 2014 Aug;11(4):446-53. doi: 10.1111/iwj.12326. PMID: 25040325; PMCID: PMC7950547.