Best practice recommendations for the prevention and management of skin tears in aged skin (2nd Edition)

Emmy Nokaneng, Corey Heerschap, Debra Thayer, Karen Ousey, Samantha Holloway, Kimberly LeBlanc, Debra Netsch, Holly Vance, Kevin R Emmons, Kevin Woo
22 May 2025

Skin tears continue to be a challenge for patients and clinicians, despite advances in awareness, prevention and management. They can be painful wounds, affecting quality of life and causing distress to the patient. Skin tears are associated with an increased likelihood of hospitalisation and prolonged hospitalisation time (Serra et al, 2018; International Skin Tears Advisory Panel [ISTAP], 2018). Estimates of their prevalence differ around the world and across care settings, but there is strong evidence to suggest they occur more frequently than pressure injuries (ISTAP, 2018).

Although skin tears occur across varied patient groups, people with immature or aged and fragile skin are at an increased risk (Langemo et al, 2021; Kacmaz et al, 2023). In older people and patients with chronic diseases, the risk increases due to the frailty syndrome – a ‘physiological condition resulting from the cumulative decline of multiple organ systems’ (Langemo et al, 2021). With the global rise in an ageing population, the approximate skin tear incidence of 1.5 million per year is likely increasing (Serra et al, 2018). To address this challenge, the expert group focused specifically on the issue of skin tears in aged skin as the majority of research is focused in this area. It was highlighted that further research in other patient groups is still required.

In 2018, ISTAP published the original guidance document: ‘Best Practice Recommendations for the Prevention and Management of Skin Tears in Aged Skin’, produced by a group of experts from Europe, North America, South America, Asia, Africa and Australia, and reviewed by additional international experts to reflect practice across different parts of the world (ISTAP, 2018).

The 2018 ISTAP guidelines are still widely used in practice, but the need for updated guidance in light of new evidence and debate was identified. For this updated 2025 edition of the guidelines, ISTAP have partnered with Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) and the Wound, Ostomy and Continence Nurses Society™ (WOCN®, USA). This collaboration develops the existing document into clear and definitive guidance for today’s clinical practice.

The combined group of experts met in December 2024 to discuss necessary updates based on changes to the healthcare landscape, and to include key current topics, such as impact of patient skin tone, growing number of patients living with dementia, and antimicrobial stewardship-informed practice.

The updated edition also includes the new updated ISTAP data collection tool (the ISTAP DC-Tool) and a glossary [Appendices 1 and 2]. This tool has been validated and is recommended for use in practice to enable accurate data capture in this under-reported and under-recognised area. The ISTAP DC-Tool was developed to provide an accurate method for collecting data to support assessment and management of skin tears. During June-October, 2024, a multiple-method validation process was conducted. Following a two-round consensus process, the Content Validity Ratio (CVR) and Content Validity Index (CVI) calculations were used to quantify content validity, supplemented by a qualitative narrative, based on the opinions of 15 experts, to assess face validity and provide in-depth suggestions for improvement. The finalised tool (hosted on the Microsoft™ Forms™ platform) includes 22 questions that reflect
patient/resident information, clinical features of skin tears and relevant additional details. The tool achieved an overall CVI of 0.72, indicating an acceptable level of validity. The intention is that the ISTAP DC-Tool can be used for quality improvement projects as well as research. The tool will help to inform a more precise picture of the true prevalence of skin tears.

Skin integrity is key to wound prevention making prevention strategies and preservation of skin health of paramount importance. This updated guideline aims to provide all clinicians with the information and resources they need to prevent, assess, classify and treat skin tears in practice with confidence, improving patients’ overall skin health and outcomes. 

Emmy Nokaneng, Chair

Download the PDF below to access and download the full document.

Disclaimer: International Skin Tears Advisory Panel [ISTAP] have partnered with Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) and the Wound, Ostomy and Continence Nurses Society™ (WOCN®, USA) with the support of Essity, Smith+Nephew and Urgo Medical to produce this resource
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