Skip to content

A skin tear is a traumatic wound that is caused by a mechanical force. The mechanical force could be shear or friction, or it could be the result of removing an adherent dressing.1

Skin tears can lead to partial or full separation of the skin’s outer layers (epidermis and dermis). They can also lead to a separation of both the epidermis and the dermis from the underlying structures (a full-thickness wound). The severity of a skin tear varies, depending on the depth of the wound. However, skin tears do not extend through the subcutaneous layer of the skin.1  

They can occur on any part of the body, but are most common on the hands, arms and legs.1

Type 1 Skin Tear

Type 1 Skin Tear

Type 2 Skin Tear

Type 2 Skin Tear

Who are at risk of getting a skin tear?

Our skin is the body’s first line of defence. It acts as a protective barrier, and prevents damage to our internal tissues and organs. However, if our skin becomes frail or fragile, it’s more likely to be damaged. This increases the risk of skin tears, as less force is needed to cause a traumatic injury.2

While skin tears can happen in a variety of patients, the elderly population is particularly at risk. As we age, our skin becomes more fragile. The skin’s ability to heal itself slows down, which can make it even more vulnerable to skin tears.2 

If an elderly patient needs help to carry out daily tasks, such as moving around or washing, this can increase the risk of skin tears. Additionally, elderly patients who have other illnesses, are undergoing certain medical treatments (e.g. chemotherapy) or are on certain medications (e.g. steroids), can have an even higher risk of developing skin tears.1

How do I prevent skin tears in my patient?

To prevent your patient from getting a skin tear, you can take two steps. One, find out if your patient is at risk. And two, take steps to minimise your patient’s risk. Let’s look at two tools that can help you to do this.

Tool #1: The Skin Tear Risk Assessment Protocol

To find out if your patient is at risk, you can use the Skin Tear Risk Assessment Protocol (See Figure 2).1

This protocol looks at three main risk factors:

  1. skin,
  2. mobility, and
  3. general health.

Figure 2: Skin Tear Risk Assessment Protocol1

Skin Tear Risk Assessment Protocol

Tool #2: The Risk Reduction Programme Checklist

If you find out that your patient is at risk, use the Risk Reduction Programme Checklist (See Table 2). This will help you protect your patient from skin tears. The checklist gives you a list of tips and suggestions based on the same three factors as the risk assessment: skin, mobility and general health. By controlling the risk factors around your patient, you can help them maintain skin health and avoid injury.1

Risk factor What you should do

Skin
  • Assess the skin and find out if the patient has had skin tears in the past.
  • If your patient has dry, fragile or vulnerable skin, assess the risk of accidental trauma.
  • Manage dry skin and use emollient to rehydrate the skin.
  • Create an individualised skin care plan using a skin-friendly cleanser (not traditional soap) and warm (not hot) water.
  • Use silicone tape and cohesive retention bandages to Prevent skin trauma from adhesives, dressings and tapes.
  • Consider medications that may directly affect the skin (e.g. topical and systemic steroids)
  • Be aware of increased risk to due age extremes (e.g. very young or elderly)
  • Talk about using protective clothing (e.g. shin guards, long sleeves or retention bandages)
  • Avoid sharp fingernails or jewellery when you’re in contact with your patient.

Mobility
  • Encourage your patient to be active and exercise
  • Avoid friction and shearing when you’re moving the patient.
  • Use good manual handling techniques (check your local guidelines)
  • Conduct a falls risk assessment
  • Make sure your patient wears sensible/comfortable shoes
  • Carefully put on clothing and compression garments
  • Make sure the environment is safe (e.g. remove any obstacles that the patient could trip over or run into)
  • Use padding for equipment and furniture
  • Assess for potential skin damage from pets

General health
  • Teach the patient and carers about how to prevent skin tears
  • Actively involve the patient and carers in decisions
  • Optimise nutrition and hydration (refer to a dietician if needed)
  • Refer to an appropriate specialist if the patient has problems with sensory perception (e.g. diabetes)
  • Consider how medication and polypharmacy might affect the patient’s skin