Good morning and welcome to HEN hospital acquired conditions affinity call. All
participants are in listen only mode. Should you need assistance, please press*zero to
reach an operator. After today's presentation, there will be an opportunity to ask
questions. To ask a question, press*one on your touchtone phone. To withdraw your
telephone, press start to. Please note that this event is being recorded. I without like to
turn the conference over to Tracy wetland.
Good morning everybody. Thank you for calling in. I hope we have a great audience
out there of [indiscernible] specialist and quality improvement people and front-line
staffers as well because this topic will relate to everybody. Today we are really
blessed to have Heather Hendrick -- she has a PhD in physical therapy, board certified
in [indiscernible] edema therapy. And associate professor. Was most recently a
speaker on skin and would challenges of people of color at the wound nursing
Society, 46th annual conference in Eugene this year.
We are very happy to have her here. The first thing I want to do is tell you that her
resume is posted, along the call the other information on that direct link that you see
on the agenda here. We will show slides and sure you resources. So we do not run out
of time at the end of the call.
Michelle, if you are out there listening, please pull up that word document -- the
Adobe document, I am sorry. This is the pressure station document. We will put this
off -- print this off and use it for training. It has good illustrations and it -- in it. It is
really a useful tool for orientation manuals as well.
Without further ado, I would like to bring Heather on board and turn the call over to
her. If you bring up the slides, Michelle, we will be ready to go.
Thank you. Tracy, can you hear me okay?
I can hear you great.
Wonderful. I am honored to be here today and I appreciate everybody's participation. I
know I have a lot of slides but I do promise I will make sure we stick to the timeline. I
want to make sure you at least have the information for you. I may not go over
everything in the slide particularly those things that are relevant for care providers and
people caring for pages, particularly of darker complected skin so we can do a better
job of Peart.-- detecting the skin changes early.
These are the objectives listed today. I want to share with you a background of
pigmentation. We will talk about some of the particulars of skin assessment that we
should really be focusing on, particularly in operations of color, because we need to
not just rely on our vision. We need to know what we are looking for. And then I want
to share with you some normal and then some abnormal variations, dermatological
variations in non-Caucasian skin. Things that we need to be aware of as healthcare
providers so we are properly calling things for what they are and documenting
accordingly.
What does the term skin of color and compass? It is an accepted dermatologic term
that is meant to describe people with all different shades of color. One of the most
common things we hear in the dermatology literature, is a sixpack tick scale. It is a
scale that is used depending on how people do and sun exposure. Their time to burn or
whether they can. Most people are at a 3 or 4, if you look at this happy face smile
here. When we are talking about skin of color, we are talking about ethnic skin that
involves Asians, Africans, Afro-Caribbean's, African-Americans, aborigines -- sorry,
Native Americans and Hispanic. And Asians are also divided into Pakistan, India Sri
Lanka, Southeast Asia, and Eastern Asia.
Excuse me. I am doing this webinar from home so I would not be disturbed by
students and here is my dog.
As you can see, there is quite a variety of difference -- give me one second.
My sincere apologies. We will get back on track. Probably would have been better to
have my students interrupting me.
Okay. This is the Fitzpatrick pigmentation classification scale I was talking about.
You can take your time to look at that and see where you may fit in or some of your
patients may fit and. Like I said, most people, when we are talking about skin of color,
type III, type IV, type V, Six. These are the pages that we need to pay particular
attention to will me during our assessments.
80% of the world's population involves patients with pigmented skin. That is a pretty
significant consideration when you are looking at the number of people that we are
potentially dealing with.
If you look currently, Andy you're going to have to hit the tab to bring up the feature,
the population of the United States is roughly 29% Caucasian right now. But by 2050,
it is projected that 48% of the US population would be non-Caucasian. That is a really
significant finding because we need to prepare as healthcare providers to know what
to do and how to best care for these patients so that we are not letting skin lesions
progress to really complicated situations.
Interestingly, there was a report by Dr. Leiter that said that the Latino and Hispanic
and even the black population are the fastest-growing among those 85 years and older.
They often tend to be the ones that are important help them more at risk for [ NULL ]
applications . It is really important because the aging population is continuing to grow
and the largest segment of the population tends to be non-Caucasian.
This slide just breaks down the normal skin color and is pigmentation. It is a mix of
melanin, carotenoids, oxyhemoglobin and reduced hemoglobin. The interesting thing
is not how many melanocytes you have or how fast it is produced, it is actually the
amount of melanin that is the principal determinant of skin color. It is interesting as
well because there are two different types of skin color. One is constitutive. That is
our genetically determined level, what we are born with. We also have succulent of
skin color. This is an induced level of epidermal melanin due to things like radiation,
were months other environmental factors. Those two things, constituted and
speculative components come together and that is what gives us our skin color.
The pigment melanin is produced by melanocyte. Interestingly there are no significant
difference of the actual number of melanocytes when you look at Caucasian and
notification patients. However, where the difference comes in is the rate at which the
melanosomes are produced and Mellon ized. So darker complected individuals tend to
have a faster rate in which there melanocytes reduce melanin and deposited into the
skin.
As far as pigmentation, the distribution within the monocytes and care set-asides does
differ. It is a little bit differ between sc -- skin pigment. Interestingly there's a
component copy sign eight and this is a copper containing enzyme that is strictly
involved in melanin synthesis. What happens is these levels are 10 times higher of
people of African descent. So they tend to produce 10 times more melanin then
melanocytes in the Caucasian counterparts.
Interestingly, people with albinism, a complete lack of melanin, and I'm sure you've
seen some of these people -- they existed human and animal species, there is a
complete absence or defect in their production of tarot sign in. Interestingly, those
with albinism, do not accumulate so there's very interesting research -- that may be
something that we will see within the future. Why is all of this important. The
problem is R looking at our patients, particularly patients with pigmented skin, they
really is not a standard guidance or evidence to tell us what we specifically need to be
doing. We need to understand racial difference and skin function in appearance that
we do proper skin care, better prevention, early recognition and intervention. But it is
important to remember that there's not a lot of differences within the integumentary
system across differences -- I'm sorry, across ethnicities.
Back in 1998, it is the data study, lighter and his group looked at the ability of the
scale. That is our most common risk assessment tool that we use that there. He
particularly looked at it and looking at black, Latino and Hispanic elders. Statistically,
it revealed that the Braden score significantly under predicted those participants at risk
for pressure ulcers. We have a need to develop a risk assessment tool specific for our
patients of non-pigmented skin. I know Dr. Leiter and his group are looking at doing
that, I have not heard any recent updates as to where they are with that. But I would
charge anybody out there to consider doing this because it would be a huge benefit to
the wound care community.
Although, when we are looking at black skincare condition, although the thickness of
the skin does not vary according to skin color, the strata corneum, the outer layer of
the skin, and dark of people contains more layers of corneal cells. They are more
tightly compacted. Their protective mantle, i.e., the skin, is more robust despite the
fact that it contains fewer surmise. Semites are essential lipids that are needed for
moisture. Because of the slower amount of surmise, black skin, particularly when it is
dry, appears as she. That is just telling you that the skin does not have enough Voice
Tracer nation so we need to add motion to that skin and I'll talk about that shortly.
The pores, sweat glands are larger and black skin. They do tend to produce more see
them around her follicles and a lower pH so they have a more thicker skin than their
Caucasian counterparts. Because of this, this is why black skin is a little more prone to
scarring from acne and spontaneous peeling. However, on the other side of the coin, it
is also less sensitive to certain chemicals that tend to irritate the skin by Asian people.
This is why you see different products more for African-American skin versus more
for Caucasian skin.
Overall, what is really recommended, regardless of skin color, but particular
provisions of epic skin tones is to use products that contains squalling. That is just a
fancy word for all of oil. I would like to add to that to suggest that you consider using
products that contain pure coconut oil. These two products, what is nice about these
two products, is that they do not conclude the skin, they are highly penetrable, and
they really provide sustained more sure as Asian. They are very healthy for the skin.
The other thing I like to state, and this is my own rule of thumb, if I cannot pronounce
something on the label, I definitely do not want to put it on my skin. You have to
remember that I was skin absorbs up to 60% of what we put on it. I am much more
comfortable putting pure coconut oil on my skin than something that has pronounce it
is 50 different ingredients listed in it. Just be mindful of that when you are selecting a
product formularies, just keep in mind what my these -- might be the most simple,
pure and natural product for your patient.
When we look at some of the structural differences in the strata of corneal, the outer
layer of our skin, we find it has equal thickness, however they have lower ceramide
levels but they have much more compact cell layer cohesion which affords them an
increased resistance to stripping. If you were to remove dressing or something like
that very quickly, they tolerate that a little bit better. Again, I'm not suggest we do that
or handle these patients a little bit more roughly, but their skins tend to tolerate that a
little bit more.
Overall, black skin does have a higher lipid content overall. This is why when we are
looking at some of our elderly African-American patients, they have it very graceful,
almost wrinkle free aging appearance of the skin. It is just beautiful. The only
difference is they do have a decreased level of ceramide, that particular fatty acid or
thallium -- fatty lipid. This is why they tend to have that ashy appearance.
They do have an increased number of fiber blasts and the skin overall tends to be a
little bit more physiologically active. That is just really just the mean a specific
differences in the outer skin layer.
Assessment basics. If you can just hit the forward button again. On the left, this
describes the minimal skin effect components. There are a lot more things that should
be done but this is a minimum skin assessment. Color, texture, moisture, integrity.
When during wound assessment, minimal wound assessment involves a very thorough
patient examination looking specifically at the wound and then looking at all those
different wounded characteristics. These are the basics of what you should be doing.
The minimal things you should be doing when you're looking at patients addressing
their skin and looking specifically at their wounds.
I think what is important, and I like to go to collect my, any time you are doing any
time -- kind of assessment, especially wound assessment, it is really important that we
look at the whole patient and not just a whole that is in the patient. So we really need
to appreciate everything that is going on with that individual. What is key, particularly
our non-Caucasian patients, is visual inspection alone is not enough. Everybody is as
look or era Cima, do a visual inspection of the skin. That is critically important, we do
need to look at the skin, look for different lesions, but what we are talking about nonCaucasian skin, it is impaired if we do throw palpation. We want to see can we detect
temperature differences, tissue consistent did differences, because you may not see air
Cima but you may pick up a slight issue, temperature discrepancy. This patient feels
very hard or this feels boggy. You will not pick those things that, though subtle
changes Emma if you're only looking at the skin. When we are looking at the skin,
with particular attention to the lighting in the room.
As you know, many times in different settings, the room light is not adequate. So what
we need to make sure is if we cannot adjust the room light or open the blinds or
drapes, have a penlight or some type of flashlight that is handy when you are doing
your assessment see you can really get a good picture of what is going on with those
individuals. Of course, it is important to talk to our patients about their skin and
wound history. If they're not able to or there is a caregiver or health care proxy or
family member, if there is a wound, we need to pay attention to the smell after we
have clans the room and to get an idea what might be present there. But we also need
to listen to our patients. Oftentimes, they will tell us exactly what is wrong even
though they may not have the medical terminology. A lot of times we dismiss what
they are saying or you do not really know what you're talking about, that sort of thing,
but really pay attention to those patients. Especially if you have a patient with
neuropathy and all of a sudden they're complaining of deep pain in the foot. That to
you should be a red flag that there may be a deep infection going on because true
neuropathy, they will not have any sensation.
Same thing, if people are complaining of aging at the heel, is a very strange location
for an edge. What we have to remember is itching is a subset of pain. This might be
the first physical manifestation of tissue change due to ischemic change that the
patient is asked -- experiencing. Do not to say, your heel itches, we will put cream on
it, let us look at why that heel itches. It could be due to the fact that they experienced
some type of -- some type of tissue ischemia.
Here's the meat and potatoes of what we're getting at today. Black skin may respond
to trauma or information by either an increase or a decrease in pigmentation. Note, I
did not say air Cima. You will not see this redness. You might on a lighter complected
application, but you will not see true air Cima like you would in a Caucasian patient.
What we are looking for is called disk R. The melanocytes respond in an exaggerated
way and there is a Mark change in patent. It is lighter and darker than the patient's
national can collect. Dischromia, following an inflammatory event, is known as a post
inflammatory hyperpigmentation .
What this means is that there is an increase in melanin production or in an even
distribution of melanin. This excess pigment is either in the epidermis only or
epidermis and dermis. If it is in the dermis, tensile as a little bit longer. Remember it is
our epidermis turns over about once a month. This is what we are looking for. Either a
hyper or a hype oh pigmentation, particularly when you expect -- suspect there might
be subtle skin changes.
This is an example. Mind you, there should be a glove on this nurses hand, however,
if you look at the wound, which is that the lateral knee, you can see the wound. It is
right at the fibula had. Look at the dark -- darkness around at the period wound area.
Appear a wound by definition is three or 4 cm beyond the wound edge. Is period
wound area, look out dark that ring of tissue is. That is post inflammatory
hyperpigmentation. This is era Cima. This is how it will percent on a non-Caucasian
patient so you're saying the darkening of the skin down. Sometimes it is very obvious
and other times it is a little bit lighter.
These are two other examples. This is also post inflammatory hyper and hypo
pigmentation. Hypo pigmentation represents either a localized , which you can see in
both of these pictures or a wide spread loss of melanin in the skin. Both of these
pictures assuring you patients that had, [indiscernible] but a lot of these ones have
resolved. So we have stage for pressure ulcers. In the areas where that tissue has
resurfaced and I have scar tissue, look at the hypo pigmentation. You can see it in
both pictures. We are not exactly sure why this happens. A may be due to a loss of
functional melanocytes but the way presents is these deep pigment macules are
feathered like edges. What you can start to see, particularly the top picture, those little
small dots of darker, regular pigmentary color coming back. That is how in time this
area will be paid Midshipman When the patient presents like this, this can be socially
stigmatizing to patients because it is a very much of a contrast to the normal skin
color. You can reassure them that over time this area should repayment. It might be a
little bit darker slightly lighter than the normal skin time but -- tone added time it will
return to normal skin color.
Again, these are examples of how the skin reacts after wounding. Many of these
pigmentary alterations will normalize over time. Pigment is transient. It can take
months or years to normalize. In both of these pictures, you can see the
hyperpigmentation where a lot of it is very pink, you can start to see those macules of
three pigmentation starting to come in. They will continue to get larger and grow
outward until that whole area has been resurfaced with new pigmentation. Again, it
may be lighter or darker. It may be hyper pigmented or hypo pigmented. Once the
wound has resulted close, it is very important to start using good lubrication on the
areas, olive oil of coconut oil, to give this area is moist and indicated.
-- Lubricated.
I want to talk about normal variations in black skin. I will go through these relatively
quickly. I picked this out of the whole bunch of them because is a must, things you
might see in some of your patients and some of your residence. I think it is important
to recognize them for what they are. They are normal variations in black skin. We are
not talking abnormal.
This is something called of future or for slide. You will start to see a sharp
demarcation on the biceps where you see one side of the arm looks a little bit darker
where the medial side of the arm looks a little bit lighter. This is a completely normal
dermatological variance. It is in about 25% of heavily pigmented people. It is more
common in women. 79% of black females had at least one type of the slides. It is
more common on their arms. It is very benign. If you see this, you do not want to
think there are ischemic changes going on or some type of strange [indiscernible]
issue. This is a normal, benign condition.
This is interesting. If you look at the sternum of this individual, your first thought is
that he had open heart surgery. Actually, this is called midline hypo pigmentation.
This is not scar tissue. Just a linear band overlying the sternum. We do not know its
etiology but its incidence is approximately at most 40% and black individuals, were
common in males, and does become less common in age. If you're doing skin
assessment, you do not want to document this is scar tissue from his surgery. This is
why our histories are so important they have no history of cardiac problems or any
like that, most likely this is a normal dermatological variant called midline hypo
pigmentation.
This is an important slide. For one thing, it is important to recognize that when we are
doing skin assessment, we need to also look at the quality of the hair and the quality
of the nails. Hair and nails are extensions of the skin. Just a thicker form of keratin. A
lot of our darker complected patients, in fact over 50% of them, have these
longitudinal melanin key alliance. These are linear hyper pigmented streaks. You will
see this if you start looking for. There is a positive correlation with advancing age. It
can be due to some drugs or systemic diseases, but what is important and what I
wanted to start paying attention to, is an irregular nail pigment or history of a
changing lesion in the nail warrants a biopsy. 20% of melanomas and black people are
found in the nails. 20%. If you see the streaks or a lesion in the nail, or something is
changing or something does not look right, I am not saying biopsy the streak, I'm just
saying or something is change where you see a new lesion appearing, the request of
biopsy. Melanoma kills more black people every year than it does Caucasians because
we do not detective. We do not think black skin can get skin cancer. Absolutely. In
fact, this is how Bob Marley died. He died from malignant melanoma of the toe, it
metastasize from his tone to the rest of his body. We need to be better, acute observers
of these things that we can detect them before they become problematic.
This is something that I think is also important. This is called Pall Mall LANguard
hyperpigmentation. Even those this picture shows the plantar aspect of the feed, you
can see this exactly on the Palmer aspect of the patient stands. This is due to a
localized hyper melanosomes. So you get these old tiny black macules. You can
sometimes see it in the creases. I do not want people to assume that these are ischemic
changes or a shower every blood clot or it is Kaposi's sarcoma. It is none of that, it is a
benign condition and something you may see in some of your patients. You need to
recognize that it is a normal dermatological variance.
This is called, and it is always fun to pronounce idiopathic [indiscernible]
melanosomes. What ever it is call, small, light irregular shaped macules usually on the
lower anterior legs of women. It may be due to sun exposure, we are not exactly sure,
but if you look at it from a histological Stempler, residues number of melanocytes in
that area. Some patience my ask you why is this happening, why is my leg started to
get is a white spots? It is a normal dermatological variance. We do believe it may be
due to sun exposure and it is possible that those melanocytes just quit working. I see
this even a Caucasian patients as well. It is a benign condition.
This you may see fairly regularly as well. In fact, work in Freeman has this. And if
any of you are matrix fans, the Oracle, if you remember, she had this condition. This
is called Dermot doses populaces [indiscernible]. Over 80% of black individuals may
be affected with this. Unfortunately it does tend to affect the face, neck, son born
areas more than the other body parts. It does peak in the sixth decade of life. They are
called flesh molds, do not require treatments although some people do seek cosmetic
excision but you do run the risk of scarring. It is benign other than maybe just being
has medically challenging to patients. Nothing to be of concern. Not metastatic cancer
anything along that line.
There are often a lot of disorders as well that can cause emotional stress and social
stigma. Most of these can be seen in various ethnicities. We have things like albinism,
elastomer, different types of freckles, liver spots, the whole gamut. We need to
recognize them for what they are. Realizes some of them are modifiable and some of
them are not. Oftentimes some patients do elect to get tattooing done so that it
normalizes their skin tone. We need to be sensitive to what some of our patients are
experiencing are presenting with and document what you are seeing.
I also want to briefly bring out some of the impact of culture, cosmetic customs, tribal
and social markings. There is a lot of traditional medicines or folk medicines that go
on today, such as cupping, Corning, spooning, that we may need to recognize. These
are widely practice alternative forms of medicine. Oftentimes it is social identification
to create marks on the skin. We need to recognize that, ask questions, because this
type of information is not always volunteered so it is okay to ask those questions.
Realize that some of it can impact how the skin functions or how I wound may help.
Oftentimes, the results can be burns or bruising or petechiae or are the types of scars
or even [indiscernible] formations. I think we need to recognize that and be mindful of
those differences.
Through all of this, what I think is important is that, like I said before, iracema are
looking for that blanching skin are not going to be reliable indicators on their own
when we are looking at our Caucasian patients.
What we need to do is use our senses. We need to look. What is normal for the
individual? Compared to the surrounding area, surrounding skin, contralateral side. Is
there an area question the site of a previous injury, scar tissue? Listen to the
individual. Are they complaining of pain, itching, earning, other sensory changes?
When you're a palpating it, is the area warmer or cooler, firmer or Bobby? One thing I
can suggest, this is anecdotal, some of those pediatric for head strips that you can use
to take temperatures on children can be very useful to use clinically on an area of
impact skin because it can tell you settle to shoot temperature changes that they exist.
That might be able to help you discern those minute changes there. But really feel
around. Do something for you firmer or Bobby, we are looking for those types of
changes because that is telling you something is going on that we need pay attention
to.
As we know, iracema, traditional signs of inflammation, building I would say that we
would replace the it is the word iracema with the word to scrum yet. I mentioned the
condition about itching. We need to pay attention to that. Changes in skin collar and
temperature you see and feel can also be due to the inflammatory process. Our failure
to the tech that may increase the risk of our patient to develop a pressure ulcer wound
infection or some other competition.
If you look at these pictures, and I try to outline some of the period wound areas for
you, these are all examples of disk R. The picture on the bottom left is of a Caucasian
patient. You can see a fast area of iracema there but contrast that to the picture above
it and the picture next to it. It is a little bit harder to see that iracema. If you really
look, you will start to see that dischromia, hyperpigmentation, the darkening of that
natural skin tone. The top picture on the right, this is a young black patient that was
irradiated in what is called a mantle field for Hodgkin's disease. This outline of the
pigmentation follows precisely the irradiated areas where he received the radiation
therapy.
I am almost done, I promise. Lots of good information to share.
Are we stuck? Great. You'll have to flip through these a little bit.
Palpation again is a very useful tool to assess skin temperature, a Dema, looking at the
texture and you may be able to see this but you can feel these for accuracy. With our
older adult population, oftentimes doing that Turner test on the back of the hand is a
little risky because they end up with a skin care. You can also pinch the skin on the
chest or on the four had to look for turgor or changes. Sometimes I can be indicative
of dehydration, or just a sign of aging because of the loss of elasticity. The slide is
telling you to use your palpatory skills.
What I wanted to show you here are some differences. Both of these are pictures of on
stage both pressure ulcers. I tried to find the most two identical wound types on a nonCaucasian and Caucasian patient. Look at the peri wound area. If you look closely,
you can see it is very localized on the patient on the right . Pretty quick to get to
normal looking tissue.
If you look at the patient on the right, you can see a very well demarcated -- this is
where lighting is so important, hyperpigmentation. Disk R -- dischromia. The
inflammatory process that you see going on. It is not iracema. If you feel this, it may
feel cooler or warmer if there is an infection. And tissue changes going on as well.
Again, you have seen these pictures before. These are resolving or healing pressure
ulcers. Notice I didn't say they were healed. There and the process of closing. Because
scar tissue is present we know they are staged three or stage IV pressure ulcer. Dark
pigmented skin, when it is wounded, results in significant yet temporary pigmentary
changes. I can appear pink or hypo pigmented as the tissues go through that resolution
process. Near-normal pigmentation may be turnover time, but it will start by that
hyperpigmentation macular [indiscernible] pigmentation.
Again, note the characteristics of the wound Marchand and peri wound area. Very
localized. On the picture on the left, that you see before. If you look at the picture on
the right, this is much more diffuse. This is not just information that is going on as it is
in the picture on the left. On the picture on the right, we have something going on
here. It extends into the foot, up the lake, and a little hard to see in the picture but if
you feel around, it was hard and hot. What happened is this is a neuropathic patient
who fell asleep, unfortunately touching his space here. So he got a bird. He developed
a secondary infection. Humane up this it just by looking at it. This is why it is so
important to look at and feel the surrounding tissues.
From this photo, you see it is very difficult to determine what the -- what is viable
versus nonviable tissue. The point is, we cannot rely on visual cues alone. We must
use all of our senses.
I will and with just a couple of last-minute things. Here is something to consider.
Oftentimes these two also was present very similar. However, the ideologies are very
different. The top picture is a sickle cell ulcer and the bottom Fisher is a Venus also.
They are very similar, they can be comfortable but this circle sell tends to be
exquisitely painful. It is very common in young adult males. These are important
things to work up from a history, but also from your differential exam.
We want to rule this out with other vascular conditions. Usually what you will see a
sickle cell is there is crusting nodules. Venous ulcers do not trust. There is an absence
of hair follicles, hyperpigmentation, atrophy in subcutaneous fat, when you lose that
blood supply you lose those upper dermal appendages. This is due to the sickle cell
process. On x-ray what you see is rial steel thickening of the underlying bone
associate with the pathology. You will not see that in Venus or arterial disease.
Just quickly, this shows a clinical comparison. This is both Stevens-Johnson
syndrome. Look how it presents a non-Caucasian skin versus Caucasian skin.
Identical conditions, completely different skin manifestation.
Same thing here. This is actually Kaposi's sarcoma. Same condition but look how it
presents unknown Caucasian skin. Tend to become fluent or smooth macules all black
skin compared to elevated red, almost purple lesions intact. These are not open.
Because he is not open on my skin.
Very different clinical presentation, same condition.
This is shingles, which received quite a bit in our elderly population. This is how it
presents commonly unknown Caucasian skin. In [ NULL ] Asian skin, it is more
common to see those air some of this red pustules. You can see those sometimes in.
Complected patients but you tend to have darker looking custom pustules and you do
and Caucasian skin.
This is just the difference between maturing scar tissue on dark and light skin. Black
individuals are 2-19 times more likely to develop two points which I will defined in
the second than their Caucasian counterparts. We think that might have something to
do with those [indiscernible] levels -- tyrosinase levels.
What is important to remember is hypertrophic scar and keloid scars although they are
pathological forms of scarring, not the same thing. Hypertrophic scarring is defined -confined to the boundaries of the injury. Wears keloid scarring extends well beyond
the boundaries of an injury. For example, this was just due to an ear piercing. The
result tends to be a very overgrowth or abundance of scar tissue compared to the
actual defect.
Physiologically and histologically, there is not many differences between Caucasian a
non-Caucasian skin. It mostly comes down to the rate of melanocyte production. But
also subtle difference in the straddle cornea. Dark skin does have unique normal
dermatological variation, I only highlighted a few of them, the more common ones. I
think the take from here is up for skin assessment on any patient of any color, we need
to be very thorough and comprehensive by using all of our senses. Do not forget your
very keen palpatory senses.
As the population ages and ethnic skin populations increase, as far as skin variation,
awareness is critical. We wanted to check his condition before they start before they
the to very severe cold -- applications are problems for our patients.
I left you with a pretty comprehensive listing of resources. These are excellent
textbooks on skin of color. A lot of these information I presented to you today have
been reference from these. The dermatological at was a black skin is also available in
Spanish. I highly recommend it. It is an excellent resource. I did have permission to
use those photos.
The additional slides are other references for your information should you want
additional information regarding these topics. I will stop here. Hopefully, I left a few
minutes for questions. I am sorry I ran a little bit over. I do thank you for your time
and the opportunity to speak with you today. I will stop talking now. Thank you.
I am not sure how many people we still have on the line. I know people have the drop
off. I hope many of you were listening in. If there are any questions, we will opine up
the line to give you a chance. I appreciate you being online. I do think this is a very
informative, it will have a legacy. We will be able to poses to our website.
Good.
If the operator is still on the line, can you tell callers how to ask questions?
Thank you. We will now again the question and answer session. To ask a question,
press*one on your touch tone telephone. If you are using a speakerphone, please pick
up your handset before pressing the keys. To withdraw your question, press start to.
At this time we will pause momentarily to assemble our roster.
Thank you.
While she's doing that, I want to bring up a good point for everybody out there. This is
not just a wound care specialist job to do assessments. It is definitely to change a
culture to be able to bring -- anybody that has contact with the patient. Someone
giving it back, changing the back, helping get dressed or undressed -- even in other
areas of the hospital. From GOR to x-ray department. Other places where patients
skin is visible. It is very important to empower your people to understand that they
need to be aware and they need to be empowered to speak up about skin conditions.
Absolutely. It is okay if they do not know what it is. If they see something that is
unusual or does not make sense, just say something. Like we say in New York, if you
see something, say something. That is my mantra for skin management.
Again, if you have a question, please press star one.
We have a question. Patty Ashmore from [indiscernible].
I just wanted to say how wonderful this was. I thoroughly enjoyed it and learned a
lot.
Bank you. I appreciate -- thank you. I appreciate that and I'm sorry we had a little visit
with my dog and the background. I appreciate the comment. Thank you.
Do not have questions, but it was just great. Thank you.
Thank you so much.
If you have a question, press*one.
I really apologize for my dog. I thought it would be much quieter doing it from home
them work. [laughter]
Any other -There are no more questions in the queue.
Heather, if you do not mind, I will tell people about your CV out there and has your email address. If they want to ask specific question to you, they can send them to me at
my e-mail address and I will put those together and send them on to have their. She
can answer those. I will post those back out on our website with the presentation
recording and everything else, which will be up in about a week.
Just for everybody's information, the link is on the agenda. There is a post meeting
assessment that we do for each one of these calls. It is important that you answer those
questions is it is possible. We turn it off one week from today. After that, it will be too
late to answer those questions. I also encourage you to come maybe not do it at a
lunch and learn because the pictures are pretty vivid, but take this back to people and
empower everybody at your hospital.
Thank you so much, Heather. It is important and impacting our state here, hospital
acquired pressure ulcers especially in trying to work hard to reduce those.
Thank you for all the work you are doing. I think it is fantastic. I am honored to help
out. I am more than happy to answer any question at a time.
Great. Everybody, thank you so much. Next month, we will not be have our affinity
call because it will be our regional meeting. We will be back on in October. Thank
you very much everybody and thank you so much, Heather.
Thank you. Goodbye.