The appearance of pale, white, or wrinkled skin immediately surrounding a wound is a common observation indicating a change in the tissue’s environment. This discoloration, known as periwound skin whitening, signals that the outermost layer of skin is reacting to a physical stressor. This visual change usually signifies one of two underlying issues: an imbalance of moisture or a restriction of blood flow. Recognizing the cause allows for a precise adjustment to the wound care routine, which promotes healing and maintains skin integrity.
The Primary Cause: Maceration
The most frequent reason for the skin around a wound to turn white is maceration, the softening and breakdown of tissue from excessive moisture exposure. This process begins when the skin’s outermost layer, the stratum corneum, absorbs too much fluid from wound exudate, sweat, or saturated dressings. When waterlogged, the skin swells, loses its protective barrier function, and takes on a white, soggy, and wrinkled appearance.
Wound exudate, the fluid naturally produced by a healing wound, contains enzymes that can damage healthy skin if left in constant contact with the periwound area. Continuous exposure weakens the skin’s structure, making it fragile and susceptible to friction, tearing, and infection. Maceration delays healing and expands the area requiring recovery.
In chronic or highly exudative wounds, the constant moisture imbalance makes the surrounding skin vulnerable to this breakdown. If the white ring is wet to the touch and spongy, moisture management is the immediate focus of care.
Restricted Blood Flow and Blanching
A less common but potentially more harmful cause of white skin around a wound is restricted blood flow, often described as blanching or localized tissue ischemia. This whitening occurs when external pressure prevents oxygen-rich blood from reaching the area because compressed capillaries push the blood away.
Unlike maceration, skin affected by restricted blood flow is typically dry, firm, and cool to the touch. Common causes include a bandage applied too tightly or the wound site being subjected to prolonged pressure, such as in a pressure injury. The absence of adequate blood flow deprives the tissue of the oxygen and nutrients needed to sustain cell life.
If the pressure is not relieved, the lack of circulation can quickly lead to tissue death. When healthy tissue is pressed, it turns white but quickly returns to its natural color once the pressure is lifted. If the skin remains pale or white after pressure removal, it suggests a sustained interruption of blood supply and a substantial risk of deep tissue damage.
Immediate Management and Prevention
Addressing white skin requires specific actions based on whether the cause is excess moisture or restricted circulation.
Managing Maceration
For maceration, the goal is to protect the periwound skin while effectively managing the wound fluid. This involves changing the dressing more frequently to prevent saturation and selecting an absorbent dressing with a higher fluid-handling capacity. Applying a protective moisture barrier, such as a zinc oxide paste or a liquid barrier film, shields the healthy skin against the irritating effects of the exudate. Ensure the dressing is sized appropriately, extending only slightly onto the healthy periwound skin to prevent moisture pooling.
Managing Restricted Blood Flow
If the whitening is due to restricted blood flow or blanching, immediate management involves relieving the pressure causing the obstruction. This means loosening any tight bandages, tape, or compression wraps encircling the limb. For wounds located over a bony prominence, such as a heel or hip, repositioning the body to offload the pressure is necessary. Regular repositioning, such as every two hours for bedridden individuals, is a preventative measure against pressure-induced whitening and subsequent tissue damage.
Signs of Serious Complication
While periwound whitening can often be managed with routine adjustments, certain accompanying signs indicate a serious complication requiring immediate medical attention.
Signs of a worsening infection include spreading redness (erythema), especially if it radiates outward or forms streaking patterns. Increased pain, swelling, and warmth at the wound site or in the surrounding white skin are also red flags. The presence of thick, discolored discharge, such as pus, or a foul odor suggests a significant bacterial burden.
If the white skin is accompanied by numbness, tingling, or a cold sensation, it may indicate a serious compromise to circulation or nerve function. Seek professional help if the white area is expanding rapidly or if the skin does not return to its normal color and warmth after relieving pressure. These persistent changes, along with systemic symptoms like a fever or general malaise, suggest the body is struggling to contain the issue.