We end 2023 highlighting two different etiologies of skin conditions: inflammation and pressure. This month’s continuing education article explores facial rosacea. This chronic inflammatory disease usually develops between 30 to 50 years of age with one or more of the four subtypes: ocular involvement (itchy red eyes with blepharitis), inflammatory (papules and pustules but no comedones), flushing and erythema (with telangiectasia) and rhinophyma (enlargement of connective tissue, commonly the nose).

The other chronic inflammatory disorder discussed in this issue is hidradenitis suppurativa (HS). It is characterized by recurrent painful abscesses, sinuses, and scars; patients often go years before being diagnosed. Durgo et al performed a qualitative, phenomenologic study of 10 people with HS and identified two primary themes during the interviews: “unending symptoms” and “life becoming hard.” The patient statements illustrate their diminished quality of life and the lengthy journey to find healthcare practitioners who were familiar with this condition. Patients with HS are also more likely to have other conditions that are part of the follicular occlusion tetrad of disorders, including pilonidal sinus disease, severe acne, or, less commonly, dissecting cellulitis of the scalp.

The remaining articles in this issue (in print and online) address several facets of pressure injury (PI) care. Tzen et al evaluated older adults after hip fracture surgery and identified risk factors for mortality including malnutrition, hypoalbuminemia, frailty, peripheral vascular disease, dementia, urinary tract infections, perioperative red blood cell transfusion, and atrial fibrillation. One-year mortality was 2.5 times greater for persons with PIs. Wang and colleagues proposed a risk assessment algorithm based on their study of 469 consecutive patients, 94 of whom (27.5%) developed stage 2 or higher Pl after undergoing acute type A aortic dissection surgery.

Buchanan and colleagues share an unusual case of a 35-week gestation infant who had a PI on the nape of her posterior neck after her mother’s prolonged labor complicated by untreated gestational diabetes, an acute COVID-19 infection, and fetal malposition.

Tate and colleagues explored Pl occurrence in older persons with emergency transitions from long-term care (LTC) to the ED. The authors documented 337 residents transferred from LTC to ED, 187 of whom were admitted to inpatient care and the remaining 150 transferred back to LTC facilities. Residents in public LTC facilities were more complex and more likely to develop a new PI, especially if the residents had a mobility issue or were admitted to acute care for more than 6 days.

Nurses consistently report that they did not receive adequate education in their initial nursing school education.1 They express the need for more skin and wound content in nursing education and for continuing professional education. To add to our knowledge about what nursing students know about Pl, Bobbink and colleagues in Switzerland translated the Pressure Ulcer Knowledge Assessment Tool (PUKAT) into French. They measured student knowledge at three different time points: baseline (45.8% correct answers on the PUKAT), after a practical workshop (59.2%), and finally after clinical practice (65%) with greater but suboptimal knowledge after each progressive step.

Finally, we want you to know that one of your editors is a member of the Guideline Governance Group working on the next edition of the International Pressure Injuries/Ulcers Guideline, scheduled to be released in 2025. Anyone with an interest in PIs can register as a stakeholder and provide input into the draft statements proposed for the 2025 Guideline. The Group will also consider your peer reviewed literature scheduled for publication before 2024. If you have a research manuscript that has been accepted for publication but will publish after January 1, 2024, send your acceptance letter and manuscript to Professor Emily Haesler at [email protected]. If your research meets inclusion criteria it will become part of the guideline evidence review.2 We hope your voice will be part of the global community, providing input to create the 2025 International Pressure Injury Guideline.

Elizabeth A. Ayello, PhD, MS, RN, CWON, MAPWCA, FAAN

R. Gary Sibbald, MD, MEd, FRCPC (Derm Med), FAAD, MAPWCA, JM

1. Ayello EA, Baranoski S, Jicman WSH. Skin and wound care survey: 2019 results. Nursing 2023;53(8):30–7. 2. Haesler E, Cuddigan J, Carville K, et al. Protocol for development of the fourth edition of Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline using GRADE methods. Adv Skin Wound Care. Published online ahead of print November 6, 2023.