Preventing and treating dry, paper thin skin tears

As we get older, our skin loses its elasticity – we all know that – but one thing we may not have realised from observing our parents and grandparents is that our skin almost becomes paper thin. The smallest knock can cause our skin to rupture and bleed profusely.

If you’re going through this, you’re definitely not alone, and there are ways to prevent it from happening, and treat it if it does occur.

Cause of skin tears

Skin tears are a growing problem and without treatment, they may become chronic wounds with prolonged healing, causing unnecessary pain.

To know why our skin can tear as we age, first we need to know the basic structure of the skin. There are three layers of skin:

1. The epidermis — the layer we can see and feel
2. The dermis — the thicker second layer underneath the epidermis that contains hair follicles, sweat glands and nerves
3. The subcutaneous tissue — the fatty layer that provides cushioning and protection

There is a basement membrane between the epidermis and dermis which both separates and attaches the epidermis and the dermis to provide structural support and allow for the exchange of fluid and cells between the skin layers.

The epidermis and dermis fit together like a puzzle with the membrane between to prevent the dermis from sliding back and forth, but as we enter our 60s, these pieces flatten and can slide much easier, causing the epidermis to detach from the dermis, leading to tearing of the skin.

Prevention

Common sense comes in to play here but sometimes, a cut or scrape cannot be avoided even if you take precautions. The best thing you can do is try to be spatially aware of yourself, as well as wear long sleeves and pants where possible.

Use of appropriate equipment to assist with mobility also can be helpful in decreasing the chance of developing skin tears if you are prone to falls.

Skin care is also vital to ensuring your skin isn’t brittle or dry – this can lead to even more tears. One study of skin tear incidence in a longterm care facility showed a reduction from 180 skin tears in a six-month period to two skin tears in a six-month time period. This particular facility used a gentle, advanced skin care line with pH-balanced soap and surfactant-free cleansers and moisturisers containing amino acids.

Other creams and moisturisers that worked included ones with grape seed extract, vitamin C (ascorbic acid), and hydroxytyrosol (from olives); essential fatty acids like omega-3, -6 and -9, plus anything with a substantial amount of silicone.

Tips to prevent skin tears:

• Identify risks around your home and add foam or move out of walkways
• Ensure adequate lighting and position small furniture (night tables, chairs) to avoid bumps or knocks.
• Remove rugs and excess furniture
• Use moisturisers daily
• Wear long-sleeve shirts, pants and stockings
• Use skin sleeves if very at risk
• Remember to hydrate often and eat a balanced diet

Treatment

Sometimes no matter what you do, you can still have skin tears. So next time you or your friend/partner hurts themselves, these are the three steps to follow:

1. Stop bleeding: Cleanse using normal saline, tap water or wound cleanser
2. Recover: Assess according to the STAR scale
3. Prevent infection: Dress the wound
4. Minimise pain: Take an ibuprofen or approved painkiller by your doctor.

There are many products that that can help alleviate the discomfort of skin tears while protecting the area to allow healing. It is also important to look at your dressing choices and choose products that allow you to avoid adhesives, decrease dressing changes and maintain an optimally moist wound healing environment.

The STAR system for assessing tears, according to NursingTimes:

Category 1a

A skin tear where the edges can be realigned to the normal anatomical position (without undue stretching) and the skin or flap colour is not pale, dusky or darkened.

Category 1b

A skin tear where the edges can be realigned to the normal anatomical position (without undue stretching) and the skin or flap colour is pale, dusky or darkened.

Category 2a

A skin tear where the edges cannot be realigned to the normal anatomical position and the skin or flap colour is not pale, dusky or darkened.

Category 2b

A skin tear where the edges cannot be realigned to the normal anatomical position and the skin or flap colour is pale, dusky or darkened.

Types of products to treat skin tears

Tell us, do you often tear your skin? What is your preferred type of prevention?