Skin changes Resources

Pressure injuries are sometimes considered to be due to a lack of good nursing care. However, it has been debated as to whether the development of some pressure injuries at the end of life is inevitable. More recently, the term ‘skin failure’, which occurs in dying patients, has been introduced in the wound care literature, and it is proposed that the presence of skin failure may make pressure injury inevitable. This article defines the theories around skin failure and presents the different terminologies used to describe skin damage typically found in the dying patient, such as the Kennedy ulcer and Trombley- Brennan terminal tissue injury (TB-TTI). It also discusses the importance of healthcare professionals being able to recognise that skin changes, which appear to be pressure injuries, are due to skin failure at the end of life and be able to differentiate between these and usual pressure injuries when planning and delivering care for these patients.

Skin changes due to aging are important to distinguish from those that are due to solar/sun damage. Knowledge of the common changes in the skin as it ages will help clinicians diagnose and manage any skin abnormalities identified in elderly skin while assessing other conditions. Before exploring such skin changes, however, it is important to understand how the sun affects the skin, causing changes that are observed as solar damage. This article highlights skin changes due to aging and solar damage and what actions need to be taken, if any, to manage them appropriately.

In patients with venous and lymphovenous disease, skin changes to the lower limb(s) occur gradually, and become more serious over time if left untreated. The CHRonic Oedema Signs and Symptoms (CHROSS) Checker is a tool kit consisting of an assessment chart and key cards that have been developed to help clinicians easily identify the skin changes that occur as a result of underlying venous and lymphovenous disease, when carrying out holistic patient assessment. It also provides clear guidance on which compression products can be used to manage the disease type and severity of skin change. For clinicians unfamiliar with some or all of the signs and symptoms listed on the CHROSS Checker chart, the key cards contain further information in the form of a photograph, definition and cause of each sign and symptom listed. This article will describe the theory behind the development of the CHROSS Checker tools and explain how to use them in clinical practice.

Janice Bianchi, Independent Medical Education Specialist and Honorary Lecturer, Glasgow University