Skin Shearing (Skin Tears): Causes, Risk Factors, Prevention, and Treatment

Skin shearing (skin tear) is a traumatic separation of epidermis from dermis, or dermis from underlying structures, caused by friction + shear forces.

Mechanism

Shear force applied parallel to skin surface while tissue is anchored → layers slide → capillary rupture and tissue separation.

Risk Factors

• Intrinsic: Age (thin skin, reduced collagen/elastin), corticosteroids, anticoagulants, malnutrition, dehydration, edema, neuropathy, dementia.
• Extrinsic: Friction (sliding in bed), shear (elevating head of bed), adhesives, equipment, moisture (incontinence).

Classification (ISTAP)

• Type 1: No skin loss (linear or flap).
• Type 2: Partial flap loss (scant → moderate).
• Type 3: Total flap loss.

Treatment

• Control bleeding, cleanse with saline.
• Reapproximate flap if viable (Type 1–2).
• Non-adherent silicone dressings (Mepitel, Urgotul).
• Avoid adhesive tapes on fragile skin.
• Monitor for infection.

Prevention (Best Practice)

• Lift, don't drag (slide sheets, hoists).
• Head of bed <30° unless contraindicated.
• Moisturize bid (barrier creams).
• Protective sleeves/leggings.
• Manage incontinence promptly.
• Nutrition: protein, zinc, vitamins A/C/E.

Systematic prevention programs reduce skin tear incidence by 50%+ in care settings.