Dear Editor,
I read with great interest the article titled "Definition and Characteristics of Chronic Tissue Injury: A Unique Form of Skin Damage" in the May/June 2019 issue of Journal of Wound, Ostomy and Continence Nursing (JWOCN). I congratulate the authors on this timely and excellent article and agree with them that the etiology of these chronic skin/soft tissue injuries is not well understood and more research is needed.
I would like to clarify their statement citing my 2015 article in the JWOCN1 that indicates that descriptions of friction injuries do not include skin discoloration. I would respectfully disagree and point to the following descriptor of friction skin injuries in the case discussion (emphasis added) from my article, "Friction skin injuries were characterized by blanchable erythema or violaceous skin discoloration, lichenification (defined as palpable thickening of the skin with a rough dry appearance and amplification of the skin crease lines usually related to repeated scratching or rubbing 25), hypertrophy of wound edges (over growth and deformation of 1 or more wound edges and immediate periwound skin, different than epibole 4), skin scaling (thickened keratinized cells, peeling, and flaking 25) and shallow skin ulcerations (defined as loss of epidermis and dermis, concave, varying in size 4). All patients had blanchable erythema or violaceous skin discoloration."1(p50)
My experience with friction injuries reveals 4 characteristic skin changes: lichenification, hypertrophy/ridging in direction of chronic slide, violaceous discoloration, and ulceration. I have observed that lichenification and violaceus discoloration are always present, whereas hypertrophy/ridging in direction of chronic slide and ulceration often develop over time. As Mahoney and Rozenboom stated in their article, the discoloration persists but does not worsen and only resolves when the offending trauma stops, although it can take some time for resolution, leading me to think of postinflammatory hyperpigmentation (PIH). Further study is definitely needed and recommended and again I thank them for adding to the literature regarding these previously undescribed buttock and posterior thigh lesions.
Respectfully,
Christine Berke, MSN, APRN-NP, CWOCN-AP, AGPCNP-BC
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