Spotting early skin change and checking pressure areas

Early pressure damage may appear as pain, tenderness, discolouration, warmth, firmness, swelling, moisture change or skin that looks different from the surrounding area. NICE says skin assessment should take account of pain or discomfort, skin integrity in pressure areas, colour changes or discolouration, and variations in heat, firmness and moisture. Those signs matter even when the skin is not yet open.

Carers should pay particular attention to heels, ankles, sacrum, buttocks, hips, elbows, shoulder blades, ears and any area pressed by equipment. On darker skin tones, redness may be less obvious, so staff should pay attention to discolouration, temperature change, texture change, pain and the resident's response during care.

Practical skin-warning signs

• Pain or flinching: especially during washing, turning or putting heels on the bed.
• Colour change: redness, purple areas or darker discolouration that was not there before.
• Temperature or texture change: skin that feels warmer, cooler, firmer or boggier than nearby skin.
• Moisture and fragility: damp, broken, shiny or easily torn skin needs attention.
• Repeated marks: the same area becoming red or sore across more than one shift is a warning sign.

Frontline carers should describe what they see and escalate it clearly. They should not casually grade or diagnose a pressure ulcer unless local policy and competence specifically allow that role.

When skin looks, feels or behaves differently over a pressure area, do not wait for a wound before you act.