Q: Should the skin assessment for dark skin tones be different from light skin tones?
A: Post-acute and long-term care providers may have residents from various cultures, ethnicities and countries of origin. There has been a growing awareness to introduce inclusive skin assessments that are more appropriate for darker skin tones.
Stage 1 pressure ulcers are often undetected. Similarly, deep tissue injuries among people with darker skin are detected at a much later stage. This has led to significant morbidity, mortality and financial liability for the healthcare system.
For example, stage I pressure ulcers on a light skin tone may manifest blanchable and/or non-blanchable skin. Darker skin may not show blanching due to hyperpigmentation. Other manifestations of stage I pressure injuries are temperature changes, tissue consistency (normal, firm or boggy), and/ or sensations of pain, itching or discomfort. Lighter skin manifestations include persistent redness; darker skin colors may or may not have a persistent erythema.
There may be changes in skin sensation, temperature, firmness or localized edema. The National Pressure Injury Advisory Panel has embraced and modified the guidelines based on various skin tones and the above-mentioned visual and palpable skin changes.
For early detection of stage I pressure injury, two specific technologies are promising. The Subepidermal Moisture Technology assessment picks early stage I injuries. Another device is Long-Wave Infrared Thermography, which detects deep tissue injuries 72 hours before the manifestation of skin changes.
From awareness for skin assessment of various skin tones to the estimation of social determinants of health, it is prudent to understand the gaps of education in clinical knowledge and racial disparities to improve patient outcomes and alleviate financial burdens on the healthcare system.
Fatima Naqvi, MD, CMD, is assistant Professor at George Washington University, Geriatrics
and Palliative Care Medicine. Send her your wound-related questions at [email protected]
