A discourse on skin tone assessment: the how, the why, and the path toward equitable pressure ulcer prevention

Pressure ulcers (PUs) are a significant and costly healthcare challenge, affecting individuals with limited mobility across various healthcare settings [1]. The pathophysiology of PU development has highlighted the importance of the early detection of PUs [2], which has become an important focus of research in recent years [3,4]. The challenge however, is that the detection of PUs is influenced by multiple factors, including skin tone, yet this area remains largely underexplored [5,6]. Current research often focuses on broad assessment strategies such as risk assessment scales and visual skin assessment, but there is limited understanding of how skin tone influences the development and progression of PUs [7,8]. This knowledge gap presents a clear opportunity to improve healthcare equity by addressing how skin tone variability impacts the tissue response to pressure and shear, and the risk of developing a PU.