Skin tears: An informational handout for residents and families

Skin tears are wounds that occur when the outer layer of the skin (epidermis) separates from the underlying layer (dermis). They are common in older adults, especially those who have fragile skin due to aging, medications or medical conditions. Skin tears can be caused by minor trauma, such as bumping into furniture, scratching or pulling off adhesive bandages. They can also result from friction or shear forces, such as sliding down in a bed or chair.

Why are skin tears a problem?

Skin tears can be painful and affect the quality of life of older adults. They can also increase the risk of infection and delay wound healing. Complications from skin tears can include cellulitis, osteomyelitis or sepsis, which can be life-threatening. Therefore, it is important to prevent and treat skin tears promptly and properly.

What are the most common skin tear risk factors?¹

• Aging
• Chronic Medical Conditions
• Certain medications, such as anticoagulants, aspirin, steroids, and diuretics
• Poor mobility
• Poor vision
• Dry skin
• Dehydration
• Poor nutrition and hydration

How can skin tears be prevented?

The best way to prevent skin tears is to protect the skin from injury and keep it moisturized and healthy. Here are some tips to prevent skin tears:

• Use gentle skin care products that are fragrance-free and hypoallergenic. Avoid products that contain alcohol, perfumes or dyes, as they can dry out and irritate the skin.
• Apply a moisturizer to the skin at least twice a day, especially after bathing or showering. Choose a thick and creamy moisturizer, such as petroleum jelly, lanolin or cocoa butter.
• Wear long sleeves and pants to cover the arms and legs. Choose soft fabrics that do not rub against the skin, such as cotton or fleece. Avoid rough, tight or scratchy fabrics, such as wool or denim.
• Use protective devices, such as elbow and heel pads, shin guards, or foam padding, to cushion the areas that are prone to skin tears, such as the arms, legs, hands and feet.
• Avoid sharp objects, such as scissors, knives, or nails, that can cut or scratch the skin. Keep them out of reach or use them with caution.
• Be careful when handling objects that can cause bruises or bumps, such as furniture, doors or equipment. Move them away from the walking path or mark them with bright colors or tape.
• Use gentle techniques when transferring or repositioning older adults in bed or chair. Avoid dragging or sliding them across the surface. Use a lift sheet, transfer board, or mechanical lift if needed.
• Use non-adhesive dressings or bandages to cover existing wounds or protect vulnerable areas. If adhesive dressings or bandages are necessary, use paper tape or silicone-based products that are easy to remove. Do not pull off the dressing or bandage quickly or forcefully.

How can skin tears be treated?

If a skin tear occurs, it is important to treat it as soon as possible to reduce pain and bleeding and promote wound healing. Here are some steps the facility might use to treat skin tears:

• Wash your hands with soap and water before and after touching the wound.
• Stop the bleeding by applying gentle pressure with a clean cloth or gauze pad for 10 to 15 minutes. If the bleeding does not stop, seek medical attention immediately.
• Clean the wound with saline solution or tap water. Do not use hydrogen peroxide, iodine, alcohol or other antiseptics, as they can damage the skin tissue and delay wound healing.
• Reposition the skin flap if possible. Gently lift the flap with a sterile cotton swab and align it with the wound edge. Do not trim or remove the flap unless instructed by a health care provider.
• Apply a thin layer of antibiotic ointment or cream to the wound if there is no allergy. This can help prevent infection and keep the wound moist.
• Cover the wound with a non-adherent dressing that is larger than the wound size. Secure the dressing with paper tape or a tubular bandage. Do not wrap the dressing too tightly or overlap it on healthy skin.
• Change the dressing every day or as instructed by a healthcare provider. Check the wound for signs of infection, such as redness, swelling, pus, odor or increased pain. If any of these signs are present, contact a healthcare provider right away.
• Keep the wound dry and avoid getting it wet during bathing or showering. If the dressing gets wet or soiled, change it immediately.

Where can I get more information?

For more information about skin tears and how to care for them, you can talk to your health care provider or visit these websites:

• The International Skin Tear Advisory Panel (ISTAP)
• The Wound Ostomy and Continence Nurses Society (WOCN)
• The American Academy of Dermatology (AAD)

¹ https://woundsinternational.com/best-practice-statements/istap-best-practice-recommendations-prevention-and-management-skin-tears-aged-skin/