Archives of Dermatological Research

, Volume 311, Issue 3, pp 231–247 | Cite as

Clinical purpura and elastosis and their correlation with skin tears in an aged population

  • R. L. RaynerEmail author
  • K. J. Carville
  • G. D. Leslie
  • S. S. Dhaliwal
Original Paper


The previous research reported the results of a prospect cohort study that used logistic regression analysis to construct a risk prediction model for skin tears in individuals aged over 65 years. The model identified three baseline individual characteristics (male gender, history of STs, and history of falls) and two baseline skin manifestations (purpura and elastosis) that predicted the risk of dorsal forearm skin tears. This paper outlines the relationships between baseline skin manifestations and the risk of skin tears. Univariable logistic regression analysis was conducted of all the baseline data collected from the same-study participants to identify variables that significantly predicted purpura and elastosis at baseline. Amongst the 173 participants, 71 (41%) developed one or more skin tears, and in these participants, 52 (73.2%) displayed purpura, 41 (57.8%) had elastosis, and 30 (42.3%) exhibited both manifestations of the dorsal forearm at baseline. Four individual characteristics (age, history of skin tears, history of falls, and antiplatelet therapy) and three skin properties (pH, subepidermal low echogenicity band of the forearms, and skin thickness) were found to predict the risk of purpura. Conversely, three individual variables (age, gender, and smoking), three clinical skin variables (uneven skin pigmentation, cutis rhomboidalis nuchae, and history of actinic keratosis) and one skin property variable (collagen type IV) predicted the risk of skin elastosis. Progressive changes to the skin’s structural and mechanical properties from the underlying effects of chronological ageing, and environmental and lifestyle-related influences increased the risk of purpura and elastotic skin manifestations and concomitantly increased risk of skin tears amongst participants.


Ageing skin Clinical manifestations Elastosis Purpura Skin tears 



Advanced glycation end products


Actinic keratosis


Confidence intervals




Extracellular matrix






Matrix metalloproteinase-2


Odds ratio


Pearson’s product–moment correlation coefficient


Receiver operator characteristic curve


Standard deviation


Subepidermal low echogenicity band


Skin tears


Transepidermal water loss


Tumour necrosis factor-alpha







The authors would like to acknowledge the support of the Wound Management Innovation Cooperative Research Centre and the Australian Government’s Cooperative Research Centres Program. Robyn was a recipient of the 2013 Australian Postgraduate Award and Curtin University Postgraduate Scholarship. The authors are indebted to the residents and staff of the Bethanie Group Inc for their support to undertake this study. Our sincere gratitude to Professor Hiromi Sanada and her research team from the Department of Gerontological Nursing/Wound Care Management at the University of Tokyo for their collaboration in undertaking this research. We are particularly grateful to Dr Takeo Minematsu for assisting us with skin blotting investigations and analysis.


Dr. Rayner was the recipient of the 2013 Australian Postgraduate Award and the 2013 Curtin University Postgraduate scholarship.

Compliance with ethical standards

Conflict of interest

R. Rayner was a recipient of a 2013 Australian Postgraduate Award, Curtin University Postgraduate Scholarship, and a Wound Management Cooperative Research Centre (CRC) PhD stipend. The School of Nursing, Midwifery and Paramedicine, Curtin University, and the Silver Chain Group, Western Australia are participants in the Wound Management Innovation CRC. No conflict of interest exists among the authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Nursing, Midwifery and ParamedicineCurtin UniversityBentleyAustralia
  2. 2.Silver Chain GroupOsborne ParkAustralia
  3. 3.School of Public HealthCurtin UniversityBentleyAustralia
  4. 4.School of Nursing, Midwifery and ParamedicineCurtin UniversityPerthAustralia

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