Ask the treatment expert: What should I watch out for when treating darkly pigmented skin?

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Susan Wickard, RN, BSN, CWCN, CWS, CLNC
Susan Wickard, RN, BSN, CWCN, CWS, CLNC


What is the difference in assessing darkly pigmented skin and why is it important?

In some of the references that I reviewed, I found that the most rapidly growing population among those aged 85 and over is in the Latino/Hispanic and African-American populations. I also read a prevalence study conducted in the United States several years ago that found the most severe pressure ulcers developed among dark skinned African-American patients.  

The traditional blanching erythema identified in light skin is difficult to observe in darkly pigmented skin due to high melanin concentrations. It also is harder to spot visual signs of early changes due to pressure in darker pigmented skin. Therefore, pressure ulcers often are not identified until significant tissue damage has occurred. 

In 1998, the NPUAP set up a task force that developed a definition for stage 1 pressure ulcers that is more specific. The task force added skin temperature and appearance with persistent red, blue, or purple hues seen in darker skin tones to the definition.

Caregivers must be taught how to closely examine darkly pigmented skin in order to determine tissue damage.  A purplish/blue discoloration may be seen. If a previous pressure ulcer was present, then the healed area may appear lighter. The skin may be taut, shiny and edematous. When touched, there will be localized heat compared with surrounding skin. The area will eventually become cool. The surrounding tissue may feel harder. To determine temperature differences, it is best to perform the assessment without gloves. However, this cannot always be done.  Pain and discomfort may result when pressure is applied. 

Appropriate training is crucial for the correct and early identification of damaged tissue. 

Please send your wound treatment-related questions to Susan Wickard at ltcnews@mcknights.com.




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