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

Area of Science:

• Biomedical Engineering
• Dermatology
• Nursing Science

Background:

• Current pressure ulcer (PU) detection methods in acute care are inconsistent and prone to misdiagnosis.
• Biophysical parameters are underutilized in routine clinical settings despite their potential for monitoring skin health.
• Category I PUs present subtle changes not always detectable by visual inspection.

Purpose of the Study:

• To investigate spatial and temporal changes in skin biophysical parameters at category I PU sites.
• To assess the utility of transepidermal water loss (TEWL) and stratum corneum (SC) hydration in identifying PU-related skin alterations.
• To evaluate the influence of intrinsic factors (incontinence, mobility) on these parameters.

Main Methods:

• Thirty hospitalized patients with category I PUs were enrolled.
• Skin integrity was measured using TEWL and SC hydration at PU sites and adjacent areas (5 and 10 cm away).
• Data collection occurred over three sessions to capture temporal and longitudinal changes, considering patient factors like incontinence and mobility.

Main Results:

• TEWL was significantly higher at PU sites compared to adjacent healthy skin (P < .001).
• SC hydration showed high inter-patient variability and no clear distinction between sites, though individual profiles remained consistent.
• Higher TEWL and SC hydration values were observed in female, bedridden, and incontinent patients (P < .05).

Conclusions:

• TEWL can differentiate compromised skin at category I PU sites from healthy adjacent skin.
• TEWL shows potential as a clinical tool for pressure ulcer risk assessment.
• Further research is needed to clarify the role of hydration and skin barrier function in PU development and monitoring.