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Friction-Induced Skin Injuries—Are They Pressure Ulcers? An Updated NPUAP White Paper

Brienza, David; Antokal, Steven; Herbe, Laura; Logan, Susan; Maguire, Jeanine; Van Ranst, Jennifer; Siddiqui, Aamir

Journal of Wound Ostomy & Continence Nursing: January/February 2015 - Volume 42 - Issue 1 - p 62–64
doi: 10.1097/WON.0000000000000102

Friction injuries are often misdiagnosed as pressure ulcers. The reason for the misdiagnosis may be a misinterpretation of classic pressure ulcer literature that reported friction increased the susceptibility of the skin to pressure damage. This analysis assesses the classic literature that led to the inclusion of friction as a causative factor in the development of pressure ulcers in light of more recent research on the effects of shear. The analysis in this article suggests that friction can contribute to pressure ulcers by creating shear strain in deeper tissues, but friction does not appear to contribute to pressure ulcers in the superficial layers of the skin. Injuries to the superficial layers of the skin caused by friction are not pressure ulcers and should not be classified or treated as such.

David Brienza, PhD, University of Pittsburgh, Pittsburgh, Pennsylvania.

Steven Antokal RN, BSN, CWCN, CCCN, DAPWCA, Director of Enterostomal Therapy, HCR-Manorcare.

Laura Herbe, Clinical Consultant at Coloplast, Akron, Ohio.

Susan Logan RN, BSN, CWS, FACCWS, National Wound Clinical Content Expert, Kindred Healthcare.

Jeanine Maguire MPT, CWS, Sr. Director, Skin Integrity & Wound Management, Genesis HealthCare.

Jennifer Van Ranst, MBA, US Region Marketing Manager, 3M.

Aamir Siddiqui, MD, Division Head Plastic Surgery, Henry Ford Hospital, Detroit, Michigan.

Correspondence: David Brienza, PhD, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260 (

The authors declare no conflict of interest.

© 2015 by the Wound, Ostomy and Continence Nurses Society.