Skin tone and wound care: bridging the knowledge and care provision gap

A significant component of providing person-centred care is the fostering of an inclusive, culturally sensitive and holistic approach in clinical practice. However, discrepancies and discrimination in healthcare provision remains a pressing issue, and the discipline of wound care is no exception. Underrepresentation of diverse skin tones in medical education, and many providers’ implicit racial bias, drives inequities in wound care, such as disproportionally poor outcomes for Black patients (Johnson et al, 2023). This is highlighted by several US studies that report that pressure ulcers/injuries (PUs/PIs) are more likely to form, are more severe and are less likely to heal after 90 days in Black nursing home residents than in White residents. This, alongside a multiplicity of other contributing factors, is likely worsened by healthcare providers’ failure to recognise skin changes that signal wound development and progression (Johnson et al, 2023).

Change is happening, as indicated by several developments in the literature, including the recent publication of an international consensus document addressing the necessary signs, symptoms and terminology to facilitate high-quality wound care for all skin tones (Dhoonmoon et al, 2023); however, the progress made in research and education does not yet match the realities of clinical practice. It must be noted that, as Dhoonmoon et al (2023) do indeed point out in the aforementioned consensus document, that those commonly deemed an ‘ethnic minority’ in fact make up the ‘global majority’, a collective term for those who are Black, Asian, Brown, dual-heritage and/or indigenous to the global South, who currently represent approximately 80% of the world's population. Indeed, the UK itself is an ethnically diverse society, with data from the national census showing a decrease in the percentage of the population identifying as being from a White ethnic group, from 94% in 1991 to 81.7% in 2021. The next most common high-level ethnic group was ‘Asian, Asian British or Asian Welsh’, accounting for 9.3% (5.5 million) of the overall population of England and Wales (Office for National Statistics, 2022). This means that a wound care practitioner will likely encounter an increasing number of patients with a wider variety of skin tones in their daily practice, which necessitates faster and greater change in the way that research, education and continual professional development is conducted.