A skin tear is an acute wound where the outer layers of skin separate from the underlying tissue, often resulting in a flap of skin. These tears are common in individuals with fragile skin, such as the very old, young children, or the critically ill. The vulnerability of their skin makes it susceptible to damage from even minor force.
Internal Risk Factors for Skin Tears
With advancing age, the epidermis and dermis thin, and the connection between these two layers, known as the rete ridges, begins to flatten. This structural change diminishes the skin’s resistance to mechanical stress. The skin’s strength and elasticity become compromised, making it more prone to tearing.
Nutritional status impacts skin health. Dehydration can cause the skin to lose its elasticity and become more fragile. Deficiencies in protein and vitamin C hinder the body’s ability to repair skin tissue, while chronic conditions like diabetes can impair circulation and tissue viability, predisposing the skin to injury.
Certain medications can alter skin structure and function. Long-term use of corticosteroids, for example, inhibits collagen synthesis, which leads to thinner, more fragile skin. Anticoagulant medications prevent blood clotting and can increase bruising under the skin, weakening the tissue and making it more susceptible to tearing.
External Forces That Cause Skin Tears
While internal factors create a predisposition, external mechanical forces are the direct cause of skin tears. These forces are categorized into friction, shearing, and blunt trauma, each representing a physical stress that fragile skin often cannot withstand.
Friction occurs when skin is dragged across a surface like bed linens. Shearing forces are generated when skin remains stationary while the underlying bone and tissue shift, such as when a person slides down in a chair. This motion stretches and tears the skin.
Blunt trauma from bumping into objects like furniture or wheelchairs is another cause. For individuals with limited mobility, collisions can result in a skin tear. The removal of an adhesive dressing or tape can also exert enough force to strip away the outer layer of compromised skin.
Differentiating Skin Tears From Other Wounds
A primary feature of a skin tear is the presence of a skin flap, where the epidermis has lifted away from the dermis. This flap can either partially or completely cover the wound bed. This characteristic helps to set it apart from other common injuries.
A pressure ulcer develops from sustained pressure over a bony prominence, cutting off blood supply and causing tissue to die. It appears as a discolored area or an open crater but does not feature a skin flap. An abrasion, or scrape, is caused by friction and results in a shallow wound without a distinct, separable flap.
A laceration is a cut from a sharp object that goes deeper into the tissue. Unlike a skin tear’s separation of layers, a laceration is a slice through all layers of the skin and potentially into the subcutaneous fat or muscle. The edges of a laceration are more defined and may be straight or jagged.