Skin checks

Regular skin checks are essential for early detection of skin breakdown and pressure injuries. Timely identification and intervention can prevent progression of skin breakdown.

When to do a skin check

Head-to-toe skin checks should be conducted at least twice daily. Additional skin checks may be required in the following situations:

  • Following an adverse event, such as a poor transfer or fall.
  • During a trial of new equipment such as a mattress, shower commode or cushion.
  • When introducing new clothing that may cause friction or pressure.
  • When using a new device, such as a different leg bag system or compression garment.
  • After an episode of incontinence.
  • During changes in routine, such as travel, starting a new activity, or working longer hours.

Performing a skin check

Perform a skin check by looking at and feeling the skin.

Look

Use a mirror, take a photograph (a selfie stick can be helpful for this), or have another person inspect the skin when self-examination is difficult. For individuals unable to use a standard handheld mirror, modified inspection mirrors—such as ‘quad inspection mirrors,’ ‘handheld inspection mirrors,’ or ‘flexible inspection mirrors’—may be helpful. To examine the feet specifically, consider using an inspection mirror mounted on a telescopic arm for better visibility.

Photo by: Shepherd Center

Know what is ‘normal’ and what is not. Any change can be an issue.

Check bony prominences, as these are high-risk areas.

Look for pimples, bruising or scrapes.

Photo by: English Dermatology

If redness is present, check for blanching. Blanching indicates the return of blood supply to the tissue. Return of colour from white to pink should occur within 2 seconds. If there is non-blanching erythema, a stage 1 pressure injury is present.

Photo by: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Osborne Park, Western Australia; 2014

Pitting oedema to foot.

People with darker skin tones may not see skin changes early. It is important to feel the skin when checking.

Feel

Palpate the skin for any abnormalities such as lumps, bumps, pimples, changes in texture, or areas that feel unusually soft, firm, or “boggy”. A “boggy” feel may indicate tissue damage or the early stages of a pressure injury.
Localised heat or warmth may also suggest inflammation, infection, or another underlying issue and should be monitored closely.

Example of change in skin texture.

Image source: English Dermatology

Adapted mirror options

In cases where the individual has weak or no hand grasp, there are some simple options for holding a mirror in position, which can be helpful while performing skin care checks. Options include:

  • use of pillows to position body and mirror
  • camera on smartphone held using adapted phone holder or “selfie stick”
  • manufacture an adapted handheld mirror. Technology for Ageing and Disability Queensland may be able to assist with manufacturing a mirror, if required.
  • Contact QSCIS therapists for further advice and a pattern to manufacture a hand held mirror using a plastic mirror and perspex or thermoplastic.