Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer

International Wound Journal · 5 authors, 1 centre

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TL;DR

The central result was that TEWL was significantly higher at the PU site compared to control sites, while SC hydration showed high variability without a clear pattern.

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This study investigated spatial and temporal changes in transepidermal water loss (TEWL) and stratum corneum (SC) hydration over category I pressure ulcers in 30 elderly, predominantly White, inpatients. Temporal changes over time were generally small, with fold changes mostly under 2.0. Intrinsic factors like female gender, bedridden status, and incontinence were associated with higher TEWL or SC hydration at the PU site during some sessions. The study is limited by its small sample size, single-center design, and short follow-up period, preventing conclusions about prognostic value.

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cohort

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dermatology

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ORIGINAL PAPER

PMC10502241

Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer

International Wound Journal

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ABSTRACT

Abstract In acute care facilities, the detection of pressure ulcers (PUs) relies on visual and manual examination of the patient's skin, which has been reported to be inconsistent and may lead to misdiagnosis. In skin and wound research, various biophysical parameters have been extensively employed to monitor changes in skin health. Nonetheless, the transition of these measures into care settings as part of a routine clinical assessment has been limited. This study was designed to examine the spatial and temporal changes in skin biophysical parameters over the site of a category I PU, in a cohort of hospitalised patients. Thirty patients, each presenting with a category I PU, were enrolled in the study. Skin integrity was assessed at the PU‐compromised site and two adjacent areas (5 and 10 cm away). Data was collected over three sessions to examine both temporal differences and longitudinal changes. Skin integrity was assessed using two biophysical parameters, namely, transepidermal water loss (TEWL) and stratum corneum (SC) hydration. In addition, the influence of intrinsic factors, namely, incontinence and mobility status, on the parameters was evaluated. TEWL values at the sites compromised by PU were statistically significantly greater ( P < .001) than corresponding values at the adjacent control sites at 5 and 10 cm, which were consistent with a normative range (<20 g/h/m 2 ). By contrast, SC hydration values did not reveal clear distinctions between the three sites, with high inter‐patient variation detected at the sites. Nevertheless, individual profiles were consistent across the three sessions, and the PU site was observed to be either abnormally dry or overhydrated in different individuals. No consistent temporal trend in either parameter was evident. However, intrinsic factors were shown to influence the parameters, with females, bedridden and incontinent patients presenting significantly higher TEWL and SC hydration values ( P < .05). TEWL was able to identify differences in skin responses at skin sites compromised with a category I PU when compared to healthy adjacent skin sites. Accordingly, this parameter could be included in the clinical assessment for the identification of PU risk. Further studies are required to elucidate the role of hydration and skin barrier function in the development of PUs and their ability to monitor temporal changes in skin integrity. Keywords: acute care setting, biophysical parameters, pressure ulcer (PU), skin assessment, skin health

CITATION EXPORT

Nkemjika S Abiakam, Hemalatha Jayabal, Davide Filingeri et al.. Spatial and temporal changes in biophysical skin parameters over a category I pressure ulcer. International Wound Journal. (2023). https://doi.org/10.1111/iwj.14194

AUTHORS

5 · 1 CENTRES

Nkemjika S Abiakam, Hemalatha Jayabal, Davide Filingeri, Dan L Bader, Peter R Worsley

1 Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK