Pressure Ulcer Basics: Assessing Pressure Related Skin Changes

To be able to conduct a thorough skin assessment, including staging of PU, it is critical that health professionals understand normal and abnormal skin reactions to pressure.

Photo of a person's foot pressing against glass demonstrating the effect of Blanching of the skin as a result of unrelieved pressure.

A photo of blanching hyperaemia demonstrating the red flushing of the tissues.

Normal
Blanching of the skin is a normal reaction. Blanching is the whiteness of the skin under compression due to local occlusion or vasoconstriction of the blood supply. This is normal but it is a warning that the skin is at risk. If ignored, reperfusion injury will lead to irreparable tissue damage.
Blanching hyperaemia occurs when pressure is removed from a compressed area of tissue and the capillaries rapidly refill and dilate overcompensating for deficiencies in O2 and nutrients, which causes a red flushing of the tissues. This is a normal response and will subside within five to 20 minutes. Blanching hyperaemia is difficult to detect in dark or tanned skin.

Abnormal
Non-blanching hyperaemia is the reddened area of the skin that does not turn white under finger pressure. This indicates that the circulation has been damaged due to unrelieved pressure. Inflammatory changes are now present within the tissues. Non-blanching hyperaemia is a Stage 1 PU.


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