What is the recommended treatment for skin tears?

Treatment of Skin Tears

The recommended treatment for skin tears includes gently cleansing the wound with antimicrobial solution, decompressing intact blisters by piercing at the base, leaving the blister roof in place as a biological dressing, and applying a non-adherent dressing with appropriate emollients to promote healing. 1

Initial Management

1. Cleansing and Assessment:

   • Gently cleanse the skin tear with antimicrobial solution, clean water, or saline 2, 1
   • Take care not to rupture intact blisters during cleansing 2
   • Document the number and location of skin tears to monitor progress 1

2. Blister Management:

   • Pierce intact blisters at the base with a sterile needle (bevel facing up) 2, 1
   • Select a site where fluid will drain by gravity to prevent refilling 2
   • Gently apply pressure with sterile gauze to facilitate drainage 2
   • Do not remove the blister roof (leave it in place as a biological dressing) 2, 1
   • For fresh tears (less than 8 hours old), consider approximating margins with Steri-Strips 1

Dressing Application

1. Primary Dressing:

   • After fluid drainage, gently cleanse again with antimicrobial solution 2
   • Apply a non-adherent dressing directly to the wound (e.g., Mepitel or Telfa) 1
   • Apply a bland emollient such as 50% white soft paraffin and 50% liquid paraffin to support barrier function and encourage re-epithelialization 2, 1

2. Secondary Dressing:

   • Apply a secondary foam dressing (e.g., Exu-Dry) to collect exudate 1
   • Change dressings every 2-3 days unless excessive exudate requires more frequent changes 1

Pain Management

• Offer analgesia prior to starting any procedure, as many patients report pain or burning sensation during blister care 2, 1
• Pay attention to both acute and maintenance (background) analgesia 2
• Consider consulting a pain team for complex cases 2

Infection Prevention and Management

• Monitor for signs of infection (increasing pain, erythema extending >5cm beyond wound margins, temperature >38.5°C) 1
• Daily washing with an antibacterial product can decrease colonization 2
• Use aseptic technique for dressing changes 2
• Apply topical antimicrobials only to sloughy areas, not to clean wounds, and only for short periods 1
• Use systemic antibiotics only if there are signs of spreading infection or systemic symptoms 1

Follow-up and Monitoring

• Follow up within 24 hours, either by phone or during an office visit 1
• Monitor for complications, including septic arthritis, osteomyelitis, abscess formation, and bacteremia 1
• Most skin tears typically heal in 7-21 days but can become chronic if not properly managed 3

Prevention Strategies

• Implement prevention strategies to avoid recurrence, as skin tears are particularly common in older adults due to fragile skin 1, 4
• Identify patients at risk (elderly, those on steroids or anticoagulants, individuals with comorbidities affecting balance) 5
• Avoid skin irritants such as perfumes, deodorants, or alcohol-based lotions 1
• Use soft clothing to cover affected areas 1

Common Pitfalls and Caveats

• Do not remove the blister roof - this acts as a biological dressing and promotes healing 2, 1
• Avoid using antimicrobial dressings unnecessarily - they should only be used when infection is present 1
• Do not delay treatment - prompt and appropriate management prevents skin tears from developing into chronic, non-healing wounds 3, 6
• Avoid adhesive dressings on fragile skin as they can cause additional skin tears upon removal 4
• Don't underestimate the impact - skin tears can significantly compromise quality of life and disrupt daily activities 3