Current Perspectives on Pressure Injuries in Persons with Dark Skin Tones from the National Pressure Injury Advisory Panel

Abstract

Background Pressure injury (PI) development is multifactorial. In patients with dark skin tones, identifying impending PIs by visual skin assessment can be especially challenging. The need for improved skin assessment techniques, especially for persons with dark skin tones, continues to increase. Similarly, greater awareness of the need for inclusivity with regard to representation of diverse skin colors/tones in education materials is apparent. Objective To provide current perspectives from the literature surrounding skin assessment and PI development in patients with dark skin tones. Methods The following elements will be discussed through the lens of skin tone: (1) historical perspectives of PI staging from the National Pressure Injury Advisory Panel, (2) epidemiology of PI, (3) anatomy and physiology of the skin, (3) skin tone assessment and measurement, (4) augmented visual assessment modalities, (5) PI prevention, (6) PI healing, (7) social determinants of health, and (8) gaps in clinician education. Conclusions This article highlights the gap in our clinical knowledge regarding PIs in patients with dark skin tones. Racial disparities with regard to PI development and healing are especially clear among patients with dark skin tones. Skin tone color assessment must be standardized and quantifiable in clinical education, practice, and research. This work is urgently needed, and support from private and governmental agencies is essential.

A systematic review on the impact of sub‐epidermal moisture assessments on pressure ulcer/injury care delivery pathways

“… 15 Early detection tools and technologies are needed that can reliably detect the onset of PI/PU damage. 12 , 16 …”

Shedding new light for nurses: Enhancing pressure injury prevention across skin tones with sub‐epidermal moisture assessment technology

“…Conventional Gunowa et al, 2020). Dark pigmentation means that stage I PIs are difficult to identify and may not be visible until the skin breaks (Black et al, 2023;Narla et al, 2022;Oozageer Gunowa et al, 2020;Oozageer Gunowa et al, 2021b;Yousuf & Yu, 2022).…”

“…The presence of blanchable erythema or changes in sensation, temperature or firmness may precede visual changes. Colour changes do not include purple or maroon discolouration; these may indicate deep tissue injury' (Black et al, 2023;Dhoonmoon, 2023). These definitions highlight the challenges in subjective skin tissue assessments and the disparity in PI identification for patients with dark skin tones as the early visual signs of PI present differently (Black et al, 2023).…”

“…Colour changes do not include purple or maroon discolouration; these may indicate deep tissue injury' (Black et al, 2023;Dhoonmoon, 2023). These definitions highlight the challenges in subjective skin tissue assessments and the disparity in PI identification for patients with dark skin tones as the early visual signs of PI present differently (Black et al, 2023). Objective and early detection of pressure-induced tissue damage before the skin breaks is therefore important for PI prevention.…”

“…Objective and early detection of pressure-induced tissue damage before the skin breaks is therefore important for PI prevention. Accordingly, we considered SEM assessment technology for its utility as a detection tool for earlystage PIs for all skin tones (Black et al, 2023).…”