Impact of Skin Tone on Skin Tolerance to Shear in the Context of Pressure Injuries: Theory and Computer Modeling

Abstract

OBJECTIVETo investigate the impact of darker skin tones on skin tolerance to shear forces in the context of pressure injuries (PIs) and explore the mechanobiological hypothesis that people with darker skin may be at an increased PI risk due to altered biomechanical skin properties resulting from a lower water content (WC) as some literature suggests. METHODSThe authors developed a computational modeling framework simulating skin with varying Poisson ratios to represent different WC levels in the stratum corneum (SC), focusing on the effects of ethnicity and WC on mechanical stresses in superficial skin during weightbearing postures. Mechanical properties of the tissues were based on literature values. Pure compression and compression with shear were applied to the skin model. RESULTSA lower Poisson ratio in the SC, indicating lower WC, is associated with higher tissue stresses and more intense stress concentrations, especially under combined compression and shear loading. The initial reduction in the Poisson ratio had the most significant impact on increased tissue loading. These results support the hypothesis that the lower WC in darker skin, associated with increased transepidermal water loss, may lead to altered biomechanical behavior and increased PI risk. CONCLUSIONSThe modeling suggests that reduced WC and increased transepidermal water loss, notably present in darker skin tones, lead to higher stress concentrations within the SC, thus elevating the PI risk. Comprehensive clinical and biomechanical data across various skin tones are needed to improve the practice of PI prevention in individuals with darker skin.