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Wound care and skin tone: Signs, symptoms and terminology for all skin tones

Ethel Andrews, Harikrishna K.R. Nair, Jennifer Pearson, Luxmi Dhoonmoon, Mandika Wijeyaratne, Mohamed Waheed, Simone McConnie, Zulfiqarali Abbas

25 May 2023

While patient populations vary across the world, evidence shows that in many areas there are discrepancies in wound care due to variations in skin tone; for example, patients with dark skin are more likely to be diagnosed with higher-category pressure ulcers (PUs) (Oozageer Gunowa et al, 2017). This is due to a lack of accurate assessment and early identification; for example, the initial “redness” seen on light skin may not be present in dark skin and thus be missed in the initial assessment. The majority of existing evidence around skin tones in wound care is in the field of PUs, with a lack of evidence identified in other conditions and wound types (Oozageer Gunowa, 2022).

A literature search published in 2022 (Oozageer Gunowa, 2022) highlighted gaps in the evidence around skin tones and the need for further research in this area of patient care. Further, in wound care education, there is a need for the inclusion of dark skin tones in case studies and photographs as well as to address the gap in bias around light skin tones and lack of understanding of how to assess different skin tones (Dhoonmoon et al, 2021).

Skin changes in people with dark skin tones are not observed quickly enough on a global scale. ‘Global Majority’ is a collective term for people who are Black, Asian, Brown, dual-heritage, indigenous to the global south, and or have been racialised as ‘ethnic minorities’; globally, these groups currently represent approximately 80% of the world’s population (Campbell-Stephens, 2020).

To address these gaps, a group of global experts convened for an online meeting in September 2022 to develop this international consensus document, focusing on inclusive language, assessment, and treatment of all skin tones, to improve patient outcomes. The members of the expert group work in different areas of the world, with differing patient groups and within different healthcare systems; the aim of this meeting and the resulting document was to learn from shared experiences and provide guidance on best practice to improve outcomes for all patients, with a differing range of skin tones.

This international consensus document aims to:

Provide practical guidance on accurate assessment and diagnosis in all skin tones
Provide guidance on language and descriptors to use, aiding clear patient communication
Discuss different geographical and cultural considerations across the globe
Dispel myths relating to skin tones
Focus on the future, the need for education and how outcomes can continue to improve.

The overall aim is to improve clinician confidence in delivering best practice to all patients, with the ultimate aim of improving patient experiences and outcomes.

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