Visual verification in skin-tear risk screening of dialysis patients

Abstract

　Objective: Factors affecting skin tears include dialysis history, skin dryness, and medical tape use. All dialysis patients are evaluated for skin-tear risk. However, many dialysis patients are unaware of the fragility of their skin; therefore, a simple and accurate skin-tear screening index is required. We herein elucidated the difference in the characteristics of skin with and without skin tears.
　Method: The present, cross-sectional study enrolled outpatients and inpatients on dialysis. Information on risk assessment items was collected. Transdermal moisture transpiration and skin viscoelasticity were objectively assessed. For visual evaluation, photographs were used to compare the two groups.
　Result: Ten patients in the skin-tear group and 30 patients in the non-skin-tear group were analyzed. Purpuric mottling was detected in 90% of the skin-tear group and 6% of the non-skin-tear（p < 0.01）. Thin skin with sagging occurred at significantly different rates between the skin-tear group（90%）and the non-skin-tear group（30%）（p < 0.01）. The median measurement of viscoelasticity differed significantly between groups, at 0.16（range: 0.06-0.34）in the skin-tear group and 0.26（0.15-0.73）in the non-skin tear group（p < 0.01）.
　Discussion: Thinning skin with sagging, purpuric mottling and reduced viscoelasticity was found in the skin-tear group. This finding was consistent with the findings of previous studies demonstrating that decreased viscoelasticity due to photoaging weakens the skin, leading to skin tears.
　Conclusions: Skin-tear risk screening is indicated for dialysis patients with thinning skin with sagging and purpura associated with reduced viscoelasticity.