title: Skin fails too: acute, chronic, and end-stage skin failure.
abstract: OBJECTIVE
  To identify what has been published in the literature about acute and chronic skin failure and to propose a working definition of this phenomenon.
  
  
  METHODS
  A systematic review of MEDLINE and CINAHL to determine what has been published in the literature on the topics of skin failure, acute skin failure, chronic skin failure, multiple organ failure, end-of-life skin deterioration, and pressure ulcers in hospice from 1984 to 2005.
  
  
  METHODS
  Published papers were reviewed for content related to acute, chronic, and end-stage skin failure.
  
  
  RESULTS
  Seven articles were identified that referenced either acute, chronic, or end-stage skin failure. Additional information was identified that discussed the processes of acute and chronic skin failure and pressure ulcers in individuals in hospice care or at the end of life. Care considerations and dilemmas related to a curative versus palliative goal in wound healing were discussed.
  
  
  CONCLUSIONS
  Minimal literature exists on skin failure, yet caregivers and the public must be aware of, assess for, and consider this phenomenon in their care. Based on this literature review, skin failure was defined by the authors as an event in which the skin and underlying tissue die due to hypoperfusion that occurs concurrent with severe dysfunction or failure of other organ systems. Skin failure can be categorized as acute, chronic, or end stage. Pressure ulcers, a type of skin death, frequently occur in persons with a heavy disease burden, especially those at or near the end of life, despite good care.
authors.affiliation: University of North Dakota College of Nursing, Grand Forks, ND, USA.
authors.forename: Diane K
authors.initials: DK
authors.lastname: Langemo
authors.forename: Gregory
authors.initials: G
authors.lastname: Brown
mesh_terms: D000208:Acute Disease; D001510:Bed Rest / Q000009:adverse effects; D002908:Chronic Disease; D006040:Goals; D006304:Health Status; D006801:Humans; D009102:Multiple Organ Failure / Q000150:complications* / Q000401:mortality; D009752:Nutritional Status; D010166:Palliative Care; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011312:Pressure; D003668:Pressure Ulcer / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D017592:Skin Care / Q000379:methods / Q000592:standards; D013727:Terminal Care / Q000379:methods / Q000592:standards; D014945:Wound Healing