Skin tears and more fragile skin: how to prevent and treat it

Feb 11, 2018

Skin tears can be a scary thing. It’s often not until we tear our skin that we realise how much skin loses its elasticity as we age. The smallest knock can cause our skin to rupture and bleed profusely, and not only that – it can become much harder to heal.

If you’re going through this, you’re definitely not alone, and there are ways to prevent skin tears, and treat them quickly. Here are some commonly asked questions about skin tears:

1. How are skin tears caused?

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 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.

2. What can I do to prevent skin tears?

Sometimes, a cut or scrape cannot be avoided even if you take precautions. The best thing you can do is try to be aware of yourself and surrounding, as well as wearing long sleeves and pants where possible.

Use of appropriate equipment to assist with mobility – this can be helpful in decreasing the chance of developing skin tears if you are prone to falls.
Skin care – ensures your skin isn’t brittle or dry, which 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.
Creams and moisturiser types – 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.
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
Remember to hydrate often and eat a balanced diet

3. I have a skin tear – how can I treat it?

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

Stop bleeding: Cleanse using normal saline, tap water or wound cleanser
Recover: Assess according to the STAR scale
Prevent infection: Dress the wound
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.

4. What types of products treat skin tears?

Hydrogel sheets – These are clear or translucent water or glycerin-based products that can be used to maintain a moist wound environment. They look like a thin slice of sticky gelatin and can handle the initial fluid from a wound for the first 24-48 hours. They vary in thickness and are non-adherent to the wound base. The hydrogel sheet may be held in place with elastic net dressing or a tubular-type dressing.

Protective sleeves – The use of protective sleeves or elastic tubular support bandages that come on a roll is a good way to hold dressings in place without irritating sensitive skin with adhesive tape.

Use caution with adhesive closure strips – Adhesive closure strips are common for keeping skin tears closed while they heal, but be careful. We all know what it’s like to remove a bandaid, so it could lead to further damage if you apply an adhesive bandage.