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Pressure ulcer

A pressure ulcer is an area of skin that breaks down when something keeps rubbing or pressing against the skin.

Alternative Names

Bedsore; Decubitus ulcer

Causes

Pressure on the skin reduces blood flow to the area. Without enough blood, the skin can die. An ulcer may form.

You are more likely to get a pressure ulcer if you: 

  • Use a wheelchair or stay in bed for a long time
  • Are an older adult
  • Cannot move certain parts of your body without help because of a spine or brain injury or disease such as multiple sclerosis
  • Have a disease that affects blood flow, including diabetes or vascular disease
  • Have Alzheimer's disease or another condition that affects your mental status
  • Have fragile skin
  • Have urinary incontinence or bowel incontinence
  • Do not get enough nutrition (malnourishment)

Symptoms

Symptoms of a pressure ulcer are:

  • Red skin that gets worse over time
  • The area forms a blister, then an open sore

Pressure sores most commonly occur on the

  • Buttocks
  • Elbow
  • Hips
  • Heels
  • Ankles
  • Shoulders
  • Back
  • Back of head

Pressure sores categorized as deep tissue injury may be purple or maroon. This may be an area of skin or blood-filled blister due to damage of soft tissue from pressure. The area around may be sore, firm, mushy, boggy, warmer, or cooler compared with tissue nearby.

Pressure sores are grouped by their severity. Stage I is the earliest stage. Stage IV is the worst.

  • Stage I: A reddened area on the skin that, when pressed, does not turn white. This is a sign that a pressure ulcer is starting to develop.
  • Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
  • Stage III: The skin now develops an open, sunken hole called a crater. There is damage to the tissue below the skin.
  • Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes to tendons and joints.

Pressure sores are unstageable when the tissue at the base of the ulcer is covered by dead skin that is yellow, tan, green, or brown. 

First Aid

If you have a pressure ulcer:

  • Relieve the pressure on that area. Use pillows, special foam cushions, and sheepskin to reduce the pressure.
  • Treat the sore as directed by your doctor or nurse.
  • Avoid further injury or friction to the area. Powder the sheets lightly so your skin doesn't rub on them in bed. (There are many items made for this. Check a medical supplies store.)
  • Eat healthy foods. Bad nutrition may affect the healing process.
  • Clean the ulcer the way your doctor or nurse told you to. It is very important to do this properly to prevent infection.
  • Generally, pressure ulcers are rinsed with a salt-water rinse to remove loose, dead tissue. The sore should be covered with special gauze dressing made for pressure ulcers.
  • New medicines that promote skin healing are available and may be prescribed by your doctor.

If the pressure ulcer changes or you get a new one, tell your doctor or nurse.

Do Not

  • Do NOT massage the skin near or on the ulcer. It can cause more skin damage.
  • Do NOT use a donut-shaped or ring-shaped cushions. They interfere with blood flow to that area and cause complications.

Call immediately for emergency medical assistance if

Call your doctor or nurse if you develop blisters or an open sore.

Call immediately if there are signs of infection. Signs include:

  • A foul odor from the ulcer
  • Pus coming out of the ulcer
  • Redness and tenderness around the ulcer
  • Skin close to the ulcer is warm and swollen

An infection can spread to the rest of the body and cause serious problems. Signs that the infection may have spread  to the blood can include fever, weakness, and confusion.

Prevention

If you are on bedrest or cannot move because of a medical condition, someone should check you for pressure sores every day.

You or your caregiver should examine your body from head to toe. Pay special attention to the areas where pressure ulcers often form. Look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters.

Take the following steps to prevent pressure ulcers:

  • Change position at least every 2 hours to relieve pressure.
  • Use items that can help reduce pressure -- pillows, sheepskin, foam padding, and powders from medical supply stores.
  • Eat well-balanced meals that contain enough calories to keep you healthy.
  • Drink plenty of water (8 to 10 cups) every day.
  • Exercise daily, including range-of-motion exercises.
  • Keep the skin clean and dry.
  • After urinating or having a bowel movement, clean the area and dry it well. A doctor can recommend creams to help protect the skin.

References

Fonder MA, Lazarus GS, Cowan DA, Aronson-Cook B, Kohli AR, Mamelak AJ. Treating the chronic wound: a practical approach to the care of nonhealing wounds and wound care dressings. J Am Acad Dermatol. 2008;58(2):185-206.

Bluestein D, Javaheri A. Pressure ulcers: prevention, evaluation, and management. Am Fam Physician. 2008;78(10):1186-1194.

Updated: 11/20/2012

Kevin Berman, MD, PhD, Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, and Stephanie Slon.


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