Pressure ulcers impact around 12.8% of patients worldwide yet are preventable in up to 95% of cases with timely intervention and care (NHS, 2022). Pressure ulcers form due to prolonged pressure on the skin, which restricts blood flow and damages underlying tissues. Bony areas of the body are particularly vulnerable.
While pressure ulcers can lead to extended hospital stays, infection, and increased healthcare costs, early detection significantly reduces these risks (NICE, 2014). Identifying pressure ulcers in the early stages can often be challenging, especially in patients with darker skin tones.
Early-stage pressure ulcers, identified as category 1 or 2, involve the outer layers of skin and, with appropriate care, can be managed. Timely identification allows healthcare providers to implement strategies such as repositioning and using pressure-relieving surfaces to prevent further tissue damage (NHS, 2022).
Once pressure ulcers reach the later categories (3 and 4) they take longer to heal and may require further intervention. This can lead to much more pain, a higher risk of infection, and a significant impact on quality of life (AHRQ, 2013).
Unfortunately, pressure damage can often be missed in dark skin tones, primarily due to a lack of education and awareness around early signs of pressure damage across different skin tones.
In light skin, a common erythema, or skin redness, is often more visible during the early stages of pressure damage. For people with dark skin tones, however, erythema often appears as hyperpigmentation.
According to some research, healthcare providers may underreport or even overlook early-stage pressure ulcers in patients with dark skin tones, which can lead to missed treatment opportunities and the pressure injury unnecessarily progressing to more severe stages (Saghaleini et al., 2018).
Additionally, “non-blanching erythema” - skin redness that doesn’t turn white when pressed - a classic sign of pressure damage, is also less visible on dark skin tones.
As well as recognising that colour changes show up differently on different skin tones, it is also essential for caregivers and healthcare providers to assess the skin for other indicators of pressure damage (NICE, 2014).
Skin texture changes, like skin sponginess, are common with pressure injuries. This can occur over bony areas like the hips, heels, and elbows. In both light and dark skin tones, this texture change is felt rather than seen and should prompt immediate interventions to prevent further damage.
Pressure damage can also lead to temperature changes in the skin, manifesting as cooler or warmer patches as a result of impaired blood flow. Temperature variations are easily detectable through gentle touch, which should form part of thorough skin assessment.
Finally, itching and irritation can be an early indicators of pressure damage and patients should be encouraged to report any areas of skin discomfort promptly, especially in areas may be at risk for ulcer formation.
To ensure the early detection of pressure ulcers in all skin tones, a more holistic approach to awareness and education is essential.
Education and guidance for healthcare providers and caregivers on how to recognise the more subtle signs of pressure ulcers, and how these may differ across different skin tones is important to ensuring equitable care.
Encouraging patients and caregivers to regularly inspect high-risk areas for any unusual skin changes, looking for both visual and non-visual cues, is critical to implement early intervention and prevent more serious pressure damage occurring.
References