[End-stage skin failure: an evolving clinical paradigm between wound care and palliative care.]

Over the past decade, the concept of skin failure has received increasing international attention, including definitions such as terminal ulcers, Skin Changes at Life's End (SCALE), and unavoidable pressure injuries. In the absence of a shared Italian translation, in this paper we adopt the term "end-of-life skin lesions" to describe end-stage skin failure, keeping the term international for consistency with the literature. The emerging paradigm recognizes the skin as an organ that, under conditions of global physiological deterioration, can undergo terminal failure, especially in the last weeks or days of life, but also in highly complex acute settings. End-of-life skin lesions are often characterized by sudden onset, rapid progression, irregular margins, purplish discoloration or early necrosis, and poor response to conventional treatments, even in the presence of appropriate preventive strategies. Distinguishing between avoidable lesions and lesions expressing non-preventable multisystem collapse is crucial both for clinical practice and for medico-legal and organizational implications, in a context where terminology and operational criteria are still heterogeneous and the absence of specific coding limits epidemiological surveillance and the quality of documentation. From a healthcare perspective, the approach must focus on comfort, proportionality, and the reduction of burden: protection of residual skin, control of pain, exudates, and odor, and critical reevaluation of invasive interventions inconsistent with care objectives. In response to these needs, the Italian Wound Care Scientific Association (AISLeC) and the Italian Palliative Care Scientific Association (SICP) have initiated a collaboration to develop Recommendations for Good Clinical-Care Practice, promoting shared terminology, integrated pathways between wound care and palliative care, and educational support for caregivers for decisions truly focused on dignity and quality of life.