Skin shearing and skin friction burns are similar injuries; yet, each type of wound’s distinct traits are key to treating it successfully. 

How To Protect Skin From—And Treat—Friction And Shear Injury

Did you know the average person experiences 1-3 wounds per year? That’s roughly 24 billion injuries across the globe.

These wounds range in severity—from papercuts to traumatic injuries requiring emergency medical care. Yet, all they have something in common: every wound, by definition, injures the skin. 

Understanding distinctions between different types of skin injuries helps us improve treatment and prevention. This guide does just that for two types of wounds, which—despite their similarities—shouldn’t be confused: skin shearing and friction.

What Is A Skin Friction Wound? 

A skin friction wound—also called a “friction burn” or “skinned” wound—is either a superficial or partial thickness injury, resulting from an object or body part physically forcing itself across the skin’s surface. 

Types of Common Skin Friction Injuries (Examples)

Skin friction wounds aren’t uncommon. 

Have you ever developed blisters on the skin of your feet after they spent a day chafing inside ill-fitting shoes? Perhaps you remember slipping and scraping your knees as a kid, or getting “rug burn” when playing tug of war. 

If so, you’ve experienced a friction wound.

Friction Injury Appearance & Depth

On skin, a friction burn injury is typically a visible abrasion, blistering, excoriation, or partially denuded skin. It may look like a scrape, or a patch of skin that’s been “rubbed raw.”

Crucially, a friction wound only damages or rubs away the epidermis—skin’s outermost “superficial” layer—or that and some part of the dermis, the next layer down. 

This is what makes the wound either superficial or partial thickness. Its depth is akin to that of a first or second degree burn. 

FAQ: What Are “Superficial” & “Partial-Thickness” Wounds?

To understand wound thickness, it helps to understand how skin is structured. 

It has three layers. The epidermis covers the dermis, which in turn covers the hypodermis (also called the “subcutaneous layer”). 

Superficial Injuries Only Damage The Epidermis

First degree burns (like sunburn) and shallow splinters are superficial wounds. 

The epidermis is “avascular.” This means blood vessels don’t connect to this layer of skin. Thus, superficial wounds don’t bleed.

Instead, the epidermis is mostly composed of keratinocytes in different stages, along with a few other types of skin cells, stratified into five bloodless sub-layers:

• The stratum corneum is the protective layer.
• It upholds the “acid mantle,” a layer of corneocytes (dead keratin skin cells) that create a mildly acidic pH and protect the skin from pathogens. 
• The stratum lucidum and stratum granulosum are the next and third layer in (respectively).
• Each is made of keratinocytes on their journeys to the surface. 
• While alive, keratinocytes produce keratin, the material the body uses to create hair, nails, and the skin’s acid mantle. 
• The stratum spinosum is the fourth-deepest epidermis layer. 
• Composed of both keratinocytes and flexible “adhesive” cells (called desmosomes), this layer is responsible for keeping the epidermis strong and elastic.
• The stratum basale is the innermost layer of the epidermis.
• It’s made of newly formed (stem cell) keratinocytes , pigmenting melanocyte cells, and more connective cells
• These include hemidesmosomes: connective tissue cells that hold basal keratinocytes fast to the “basement membrane.” This membrane rests between the epidermis and the dermis. 

Beneath the epidermis is the skin’s dermis layer. 

Partial-Thickness Wounds Injure The Dermis

Common types of partial thickness injuries include paper cuts, second degree burns (typically with fluid-centered blisters), and skin broken from scratching an itch too hard. 

These injuries do bleed. They also hurt more than superficial scrapes, as dermal nerve cells sound the alarm. 

This is because, unlike the top layer, the dermis’s tissues incorporate a blood vessel network. Moreover, nerve cells, smooth muscle cells, follicles, glands, and other non-skin cells are found throughout. 

The dermis only has two sub-layers: the papillary dermis, which supplies nutrients to the epidermis, and the deeper, reticular dermis, structured by collagen cells. 

Skin Friction Wounds Aren’t Too Deep

When rubbing, chafing or “grazing” creates friction against skin—and that friction only damages the epidermis or, at worst, the papillary dermis—that’s a skin friction wound.

If the injury goes deeper, or if the physical cause of the injury differs, the injury is something else. 

What Is Skin Shearing?

Skin shearing is an injury where skin layers forcibly separate, typically due to a pressure distortion. 

The separation can be a complete break (detachment), or a partial disconnection. Disconnection is still serious, as it typically cuts off at least some of the “upward” flow of blood and nutrients through the skin’s layers.

Horizontal Friction, Downward Pressure

Skin shear happens when downward pressure (towards a person’s skeleton) and horizontal friction force combine. 

The horizontal friction catches and drags skin, forcibly separating the skin’s layers.  The epidermis is broken away from the dermis layer. Shared internal connective tissue and structures may be “pinched off,” or they may tear—the latter fully detaching the epidermis from the dermis. 

Full-Thickness Skin Shearing

The most severe skin shear wounds injure more deeply. In these cases, forces strongly “shove” the hypodermis, skin’s deepest layer. This shifts the hypodermis in relation to either underlying fascia, muscle, and bones; the dermis above it; or both. 

As with partial thickness shear, the hypodermis’ connection may be cut off or completely torn away. 

Appearance & Signs

The resource “Friction and Shearing Skin Injury,” published by The Christopher & Dana Reeve Foundation, describe the appearance of a shearing injury as “discoloration on the skin, much like a friction injury or pressure injury,” though it is distinctly deeper. 

Usually, shearing injuries happen at parts of the body where “a bone point is prominent [enough] to create the pressure when moving,” opposing the friction force. The forces “duel” is often the cause of the skin-separating injury. That said, “shearing can occur anywhere on the body.”

The resource also notes that “the body responds in the same way as with a friction injury with pain, spasticity increases, and [autonomic dysreflexia] AD.” 

Considering Complications

Unfortunately, while uncommon, a skin shear can leave portions of the skin’s surface seemingly intact. 

In some cases, “shearing is not seen at the [surface] skin level,” notes wound nurse Cathy Hess, RN, in “The Difference between Friction and Shear”—a guide published in Advances In Skin & Wound Care. Because this type of injury “happens beneath the skin,” it’s easy to miss. 

Instead of a clearly visible tear, it may seem simply discolored (like a bruise). This risks hiding the separation of the deeper skin layers—leaving that area of skin vulnerable to deformation and cell death (i.e. skin necrosis). 

Are Skin Tears A Type of Shearing Wound?

Yes. Skin tears are a type of visible skin shear injury. Specifically, skin tears are shearing wounds which clearly detach the epidermis or dermis from underlying skin, creating “a linear slash, or a wound bed of largely intact tissues covered, in part, by a loose flap of skin.” 

Skin tears account for over 50% of skin shear wounds. However, skin shear injuries where the dermis separates from the hypodermis, but there is no visible cut or break on the surface, are not classified as skin tears.

Medical Monks’ guide “Skin Tears” is a useful resource for anyone who wants to learn more about the causes, symptoms, and treatment for this common type of shear. 

Shear Vs. Friction Skin Injuries: Key Differences

Shear wounds and friction wounds differ in three notable ways. 

1. The wounds cause different degrees of injury severity. 
2. They affect skin at distinct depths. 
3. They result from different levels and directions of force. 

Depth

Friction wounds are shallower than shear wounds. 

Friction wounds are superficial or partial thickness: they only injure the skin’s epidermis or mid-dermis. In contrast, shear injuries are at least partial-thinkness, and typically full thickness. They always impact the dermis, and often injure deeper hypodermis as well. 

Direction of Force

Friction injuries stem from a single, horizontal frictive force, pushing or rubbing across the skin’s surface.

Skin shearing stems from both a horizontal friction force and a “downward” (towards the body’s interior) pressure. 

Severity of Injury

Friction wounds are typically minor and easy to treat at home. Occassionally, partial thickness (2nd degree) friction burns need professional medical care. 

Shear wounds are more serious, as they entail skin layer separation. Skin shearing is partial thickness or full-thickness. The majority of shearing wounds require professional medical care. 

What Causes A Skin Shearing Wound or Friction Injury?

Friction Wound Causes: Physical Force & Risk Factors

Horizontal friction force that rubs or scrapes some surface skin causes a friction injury. 

The mildest form of these injuries are very common. For example, foot friction blisters are skin friction wounds on the foot. Studies show 63%-72% of people experience foot pain, including blisters, due to wearing poorly fitted shoes. Moreover, up to 95% of people who hike deal with friction blisters.

A person may experience more frequent friction injuries if their skin is fragile. Moisture-Associated Skin Damage (MASD), autoimmune disorders, dermatoporosis, Ehlers-Danlos syndrome, and being very young or old, all increase the fragility of a person’s skin. 

Forces Cause Shearing, Conditions Cause Skin Shear Wound Vulnerability

Skin shearing is caused by a combination of applied pressure and friction forces in conflict. As with friction injuries, fragile skin increases a person’s likelihood of experiencing shear.

However, sheer is rarer, in part, because these types of conflicting forces are more often applied when a person has limited mobility. A person who needs to be lifted in and out of a wheelchair has less control over pressure distribution on their body as they’re lifted. If they have some paralysis, they may not even feel a shear injury when it happens.

Likewise, a person who is still mobile, yet moves by distributing their weight across multiple types of furniture, braces, walkers, and other aids, often has less control over the “downward” force exerted by their skeleton on these supports. Thus, acute, uncompensated-for friction force—like scooting forward to avoid standing on a weak leg, or abruptly slipping and falling off a chair—instantly clashes with the pre-existing downward pressure. 

Case studies and care records show instances with even minor unbalanced pressure shifts—like, adjusting a pillow behind a hospitalized person’s neck and back, without compensating lower back support in the moment—have caused shear wounds. In some of these cases, the wound worsened to ischemia and skin necrosis.

How To Prevent Friction and Shearing Injuries 

Preventing friction wounds can be as easy as wearing more comfortable shoes. But, in more complex cases, stronger preventative action should be taken. 

Prevent Friction With Surface Control & Safety

Choosing beds, furniture, medical devices, and mobility aids with appropriate surfaces goes a long way to preventing friction and shear force injuries. The medical science review “Pressure and shear: their effects on support surface choice,” published in the journal Ostomy Wound Management, found seven factors that make a medical device’s surface an appropriate, preventative measure:  

“The surface must (1) conform to bony prominences without resistance, (2) not have significant memory, (3) allow patient immersion, (4) not bottom out, (5) relieve shear caused by patient movement, (6) prevent skin maceration, and (7) provide patient comfort.”

The Cleveland Clinic emphasizes safe machine use in its recommendations for preventing friction burns. These include following instructions when using tools, wearing appropriate protective gear when riding a motorcycle, and using treadmills and vacuums with caution.

Standard Skin Shear Prevention Tips

Wound Care Education Institute covers both shear and friction wound prevention in their resource “Shearing Wound Vs. Friction: What’s The Difference?” 

The section “How to prevent friction and skin shearing” lists ten tips for caregivers, which range from the precisely tactical “Keep the head of the bed at 30 degrees or below to decrease shearing forces” to “Check in frequently” (always a useful reminder).  

Gold-Star Skin Injury Prevention: ISTAP

One of the most comprehensive guides to preventing skin shear injuries, specifically, though, is Best Practice Recommendations For The Prevention and Management of Skin Tears In Aged Skin, by the International Skin Tear Advisory Panel (ISTAP). While the focus is on skin tears, many of the recommendations can be applied to shear wounds in general—and friction injuries as well.

Highlights among ISTAP’s prevention recommendations include:

Protect Fragile Skin With Barrier Films & Creams

Barrier films and creams can protect skin from chafing, pressure sores, or irritation. 

They’re particularly useful when skin is subject to friction from medical devices, or when there’s some risk of exposure to fluid leaks. Soothing ointments like Baza Protect Moisture Barrier Cream reduce inflammation while keeping skin safe from friction and maceration alike.

Reduce or Eliminate Environmental Hazards

Bumping against surfaces unexpectedly, trying to catch one’s balance on a nearby surface, tripping, or falling can all cause serious skin sheer injuries. Create a space that’s easy to navigate, with plenty of comfortable, non-abrasive surfaces. 

Moisturize & Strengthen Skin Regularly

Strong skin holds together better, even under force.

Cultivate a skincare routine with reparative, skin-nourishing lotions. Use products with clinically proven ingredients. Retinol and vitamin B3 can improve skin’s elasticity and durability, while emollients repair the skin’s protective outer layer. 

An emollient-rich moisturizer like Eucerin Original Healing Cream replenishes the skin’s protective mantle, making it easier for all of the skin’s layers to resist tearing.  

Skin Injury Treatment: Best Practices, Dressings & Supplies

How To Treat A Skin Friction Wound

Treating a friction burn is usually fairly straightforward. The Cleveland Clinic describes three simple steps for friction wound first aid:

• Remove clothing or jewelry around the burn.
• Run cold water over the burn for a few minutes immediately after it happens.
• Cover the burn with a sterile bandage or clean cloth. Don’t wrap any coverings too tightly because that can press on the burn, causing pain and affecting how it heals.

To learn more about dressing superficial and partial-thickness wounds, check out our guides to the “Best Dressing Options for Wound Healing” and “Avoiding Infection in Shallow Wounds.”

Once the wound is bandaged, it’s usually safe to move to pain management. The Cleveland Clinic’s resource notes that acetaminophen, NSAIDs like ibuprofen, a cool compress, and aloe vera gel (if the friction wound is “small enough to cover with your hand”) are all useful analgesic options.

If the friction wound is more severe (partial thickness, covers a wide area), it’s wise to seek out professional medical help.  

How To Treat A Skin Shear Wound

Skin shearing injuries are more complex. If you suspect you’re dealing with a shear wound, it’s wise to seek out professional medical care. 

The International Skin Tear Advisory Panel (ISTAP) guide, Best Practice Recommendations For The Prevention and Management of Skin Tears In Aged Skin, linked to in the section on preventing these types of injuries, also offers useful, step-by-step strategies for treatment. 

Much of the care guidance applies well to the treatment and prevention of all skin shearing wounds.