Exploring physiological differences in injury response by skin tone: A scoping review

To explore existing literature examining physiological differences in pressure ulcer response among individuals with differing skin tones.

This was a scoping review. Articles meeting the inclusion criteria were retrieved from electronic databases including PubMed, CINAHL, Scopus, Cochrane, and EMBASE, using the keywords "pressure ulcer," "skin pigmentation," "melanin," and "risk factor." Data were extracted using a predesigned data extraction tool and analysed using a narrative synthesis.

Five papers met the inclusion criteria. Analysis of findings suggests there are potential mechanisms which may influence the skin's ability to withstand mechanical stress and its inflammatory response to damage among those with different skin tones; the structure of the stratum corneum, collagen density, fibroblast activity, mast cell density, and transepidermal water loss (TEWL). The stratum corneum can compromise skin resilience, while collagen density and fibroblast activity may impact skin strength and repair. Mast cells affect inflammation, which can exacerbate pressure ulcer damage, and increased TEWL in those with dark skin tones can result in lower water content in the stratum corneum, affecting hydration.Conversely, factors like melanosome size, hair follicle and hair fiber characteristics, sebaceous gland activity, vitamin D production, UVR protection, and desquamation rate, although relevant to overall skin health, may not directly affect the mechanical processes leading to pressure ulcer formation.

Physiological differences in skin structure may contribute to alterations in the response to pressure ulcer development among individuals with dark skin. Recognising these differences is important for targeted prevention strategies within diverse populations. However, further research is needed to explore the mechanisms underlying this association in greater detail.