Statement of the European Pressure Ulcer Advisory Panel —pressure ulcer classification: differentiation between pressure ulcers and moisture lesions

Apressure ulcer is an area of localized damage to theskin and underlying tissue caused by pressure or shearand/or a combination of these.The identification of pressure damage is an essentialand integral part of clinical practice and pressure ulcerresearch. Pressure ulcer classification is a method of determiningthe severity of a pressure ulcer and is also usedto distinguish pressure ulcers from other skin lesions. Aclassification system describes a series of numberedgrades or stages, each determining a different degree oftissue damage.The European Pressure Ulcer Advisory Panel (EPUAP)defined 4 different pressure ulcer grades (Table 1).1Nonblanchable erythema is a sign that pressure andshear are causing tissue damage and that preventive measuresshould be taken without delay to prevent the developmentof pressure ulcer lesions (Grade 2, 3, or 4).The diagnosis of the existence of a pressure ulcer ismore difficult than one commonly assumes. There is oftenconfusion between a pressure ulcer and a lesion that iscaused by the presence of moisture, for example, becauseof incontinence of urine and/or feces. Differentiation betweenthe two is clinically important, because preventionand treatment strategies differ largely and the consequencesof the outcome for the patient are imminentlyimportant.This statement on pressure ulcer classification is limitedto the differentiation between pressure ulcers andmoisture lesions. Obviously, there are numerous other lesionsthat might be misclassified as a pressure ulcer (eg, legulcer and diabetic foot). Experience has shown that becauseof their location, moisture lesions are the ones mostoften misclassified as pressure ulcers.2-3Wound-related characteristics (causes, location, shape,depth, edges, and color), along with patient-related characteristics,are helpful to differentiate between a pressureulcer and a moisture lesion