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Mosaic forms of an autosomal dominant skin disorder

at the highest risk of experiencing these traumatic wounds. Paediatric injuries are most often related to medical devices. However, among the older population, the ability to resist shear, friction and/or blunt force is naturally compromised with the ageing process. Thus, poor quality of care can lead to increased occurrence of skin tears as simple daily activities can lead to skin breakdown. Tasks such as dressing a patient, transfers and skin tape removal, if not mindfully performed, can all easily lead to a skin tear. Known risk factors include impaired mobility, activity, sensation and cognition, multiple comorbidities and polypharmacy issues (including patients on long-term topical or systemic steroids). Another problem arises from the difficulty that professionals have in diagnosing a skin tear due to physiological age-related skin variations. This fact makes the identification challenging, with the problem often only discovered when it is already too late to initiate effective primary treatment. If a skin flap is visualized early and repositioned to cover the wound after adequate cleansing, the prognosis for wound healing is more favourable as the wound will heal by primary intention. On the other hand, in the case of total ‘skin flap’ loss, or if a viable skin flap is not promptly identified and repositioned, the wound will heal by secondary intention, which takes longer and has a higher risk of further complications including delayed healing and infection. To tackle this problem, and to further the education around skin tears, an efficient classification is needed. In 2013, the International Skin Tear Advisory Panel (ISTAP) developed a new classification system to address this issue. However, classifications developed empirically can be very challenging to apply in clinical practice, often resulting in low overall validity and reliability. The main consequence is that clinicians may have an available instrument that is not accurate, leading to inadequate assessment and diagnosis, and subsequent poor wound management with negative health outcomes. In light of that, the work of Van Tiggelen et al., measuring the validity and reliability of the ISTAP Classification System across 44 countries, is fundamentally important. The authors identified an overall agreement of 80% and a mean sensitivity and specificity of 88% and 92%, respectively. This level of accuracy and agreement, verified across many different countries, healthcare settings and professionals’ skill levels, provides substantial evidence to support the use of the ISTAP Classification System worldwide. To conclude, a systematic classification system is needed to provide reliable and homogeneous reports of skin tears globally, and this would be a major step forward towards improved care.