WOUND BLOG by Matthew Livingston RN

Differential diagnosis for pressure ulcers

If its not a pressure ulcer, then what is it?

Intertrigo:

Inflammation of the skin folds caused by friction, perspiration and bioburden.

Assessment characteristics include: erythema, maceration, denuded skin, itching, odor, and satellite skin lesions

Denuded Skin:

Loss of the epidermis is caused by exposure to feces, urine, body fluids, wound drainage or friction

Assessment characteristics include: history of exposure to feces, urine, body fluids, wound drainage or friction and epidermal loss

Friction:

Mechanical force exerted on skin that is dragged across any surface. It is present with shear. (NPUAP, 2007)

Assessment characteristics include: skin is rough and red, the wound is superficial, and observation of how the skin moves across the bed surface

Shear:

Interaction of both gravity and friction against the surface of the skin; when layers of skin rub against each other or when the skin remains stationary and the underlying tissue moves, stretches, and angulates or tears the underlying capillaries and blood vessels causing tissue damage. (NPUAP, 2007)

Assessment characteristics include: Deep undermining wound and the observation of how tissue rubs against tissue

Irritant Contact Dermatitis:

Acute irritant dermatitis usually occurs after a short single exposure to a potent irritant. Wound exudate has a very irritant effect on skin surrounding a wound. Preparations such as antiseptics, adhesives, and bandages applied directly to the skin, may be contributing factors in the production of this type of skin reaction.

Assessment characteristics include: Erythematous (redness of the skin), Scaling, and Papulovesicular dermatitis

Asteatotic Dermatitis:

Inflammation of the skin related to skin dryness.

Assessment characteristics include: It is pruritic, dry skin of the lower legs with a network of erythematous superficial fissures.

The condition is common in elderly patients.

Fungal / Yeast (Candidiasis):

Skin Infection of the Skin Folds and Peri-anal area.

Assessment characteristics include: peeling, bright red rash, rash may also appear white, small pustules, intense itching and burning, skin breakdown or blistering.