Overview

A pressure ulcer, often called a bedsore, is an injury to the skin and the underlying tissue, primarily caused by prolonged pressure on the skin. Think of it like this: when you sit or lie in one position for too long, the blood flow to certain areas can be cut off, and this can damage the skin.

Pressure ulcers are most often caused by sustained pressure, but friction (skin rubbing against a surface) and shear (skin and bone moving in opposite directions) also play big roles. They commonly develop in individuals who have medical conditions that limit their ability to change positions, such as those who are bedridden, use a wheelchair, or have decreased sensation. It's important to know that pressure ulcers are not contagious. Living with or caring for someone with pressure ulcers can be challenging, impacting comfort, mobility, and overall well-being. We understand this can be a stressful experience.

Symptoms

You might notice a few different signs if a pressure ulcer is developing. It's good to be aware of these, especially in areas where bones are close to the skin, like the hips, tailbone, heels, and elbows.

• Unusual changes in skin color or texture (e.g., redness that doesn't fade when pressed in lighter skin tones; purplish or bluish patches in darker skin tones).
• Swelling in the affected area.
• Skin that feels warmer or cooler to the touch compared to surrounding areas.
• Pain or tenderness in the affected area.
• Blisters, or an open sore or wound.
• In more severe cases, the sore might look like a crater and can be quite deep.
• Pus-like draining from the sore (this can be a sign of infection).
• The area might feel firm or boggy to the touch.

Severity can range from a patch of discolored, unbroken skin to a deep wound that exposes muscle or bone. These symptoms can worsen if the pressure isn't relieved.

Diagnosis

Diagnosing a pressure ulcer usually starts with a healthcare professional carefully looking at your skin, especially over bony areas. They will check for the symptoms we just talked about.

They will also likely ask questions about your medical history, your ability to move, your diet, and how you care for your skin. Doctors often "stage" pressure ulcers (from Stage 1, which is mild, to Stage 4, which is severe, and sometimes "unstageable" or "deep tissue injury") based on how deep the sore is and what kind of tissue is affected. This staging helps guide care. No special blood tests are usually needed just to diagnose a pressure ulcer, but they might be done if an infection is suspected.

Management & Treatment

Dealing with a pressure ulcer can be a challenging and uncomfortable experience, but please know that with the right care, healing is possible. The main goals of treatment are to relieve the pressure that caused the sore, care for the wound, manage any pain, prevent infection, and support your body's natural healing process.

The first and most important step is to remove all pressure from the affected area. This is often called "offloading." If you are in a wheelchair or bed, this means changing your position frequently, at least every two hours in bed and every 15-20 minutes in a wheelchair. Special pressure-relieving mattresses, cushions, and pads can provide extra support and are essential for both treatment and prevention.

Caring for the Wound at Home

Proper wound care is critical to help the ulcer heal and to prevent infection. The care required depends on the severity, or stage, of the ulcer.

• Cleaning the wound: For open sores, the area should be gently cleaned, typically with a saline (saltwater) solution, to remove any loose, dead tissue.
• Dressing the wound: Keeping the ulcer covered with a special dressing helps maintain a moist environment, which promotes faster healing. There are many types of dressings available, including films, hydrogels, hydrocolloids, foams, and alginates. A healthcare provider can help you choose the best one for your specific needs.
• Good Nutrition: Your body needs the right fuel to heal. A balanced diet rich in protein, vitamins, and minerals is crucial for rebuilding skin and tissue. Staying well-hydrated by drinking plenty of water is also very important.

When to Seek Professional Medical Treatment

While early-stage pressure ulcers can sometimes be managed at home, it's vital to involve a healthcare professional, especially for more severe sores. They may recommend:

• Prescription Treatments: If the ulcer shows signs of infection, a doctor may prescribe topical or oral antibiotics.
• Debridement: For a wound to heal properly, it must be free of dead or infected tissue. A doctor or nurse may need to remove this tissue through a process called debridement. This can be done surgically or by using special ointments that dissolve the dead tissue.
• Specialized Therapies: For deep or non-healing ulcers, a treatment called Negative Pressure Wound Therapy (NPWT), also known as a wound vac, may be used. This therapy uses a vacuum to help increase blood flow and promote the growth of new tissue.
• Surgery: In some severe cases, a large pressure ulcer that won't heal may require surgery. A surgeon can use a flap of your own healthy muscle or skin to cover the wound and cushion the bone.

Important Considerations

• Healing takes time. Depending on the severity of the ulcer and your overall health, it can take weeks or even months for a pressure ulcer to fully heal. Be patient and consistent with your care plan.
• Pain management is a part of your treatment. Pressure ulcers can be painful. Talk to your healthcare provider about pain relief options to ensure you are comfortable during the healing process.
• Avoid using donut-shaped cushions. While they may seem like a good idea, they can actually increase pressure on the surrounding skin and make the problem worse.
• If you notice that a sore is not improving, or if you see signs of infection such as increased redness, warmth, pus, or you develop a fever, it's essential to contact your doctor right away.

Duration & Outlook

The time it takes for a pressure ulcer to heal can vary a lot. It really depends on how severe the ulcer is, your overall health, and how well the affected area can be protected from further pressure. Some mild pressure ulcers (Stage 1) might heal in a few days to weeks with proper care. More severe ulcers can take months, or sometimes even longer, to heal and may require specialized care.

Pressure ulcers can be acute, meaning they develop quickly, but without ongoing care and prevention, they can become a chronic, recurring problem. With diligent care and by removing the source of pressure, many pressure ulcers can heal. However, there's always a risk of them coming back, especially if the underlying risk factors aren't managed. Warning signs for complications include spreading redness, warmth, swelling, pus, a foul odor from the wound, fever, or worsening pain, as these can indicate an infection that needs prompt medical attention.

Prevention

The good news is that many pressure ulcers can be prevented! It takes awareness and consistent effort, especially for those at higher risk.

• Frequent repositioning: - This is key! If you or someone you care for is bedridden, aim to change positions at least every two hours. If using a wheelchair, shift weight every 15 minutes and change positions at least once an hour.
• Skin care: - Keep skin clean and dry. Use gentle cleansers and moisturize regularly to keep skin healthy. Check the skin daily for any early signs of redness or sores, especially over bony areas.
• Nutrition and hydration: - Eating a balanced diet rich in protein, vitamins, and minerals, and drinking plenty of fluids, helps keep skin healthy and promotes healing.
• Use pressure-relieving surfaces: - Special mattresses, mattress overlays, cushions for wheelchairs, and padding can help reduce pressure on vulnerable areas.
• Avoid friction and shear: - Be gentle when moving or repositioning. Use lift sheets if available. Ensure clothing and bedding are smooth and not bunched up.

Causes & Triggers

The main cause of a pressure ulcer is sustained pressure on the skin, which squeezes tiny blood vessels that deliver oxygen and nutrients to the skin. Without this, skin cells can get damaged and die.

Common triggers and contributing factors include:

• Immobility: - Not being able to change positions regularly (e.g., due to paralysis, illness, surgery, or coma).
• Friction: - Skin rubbing against bedding or clothing, which can damage the top layer of skin, making it more vulnerable.
• Shear: - This happens when the skin stays in one place (like stuck to the sheets) while the underlying bone moves, or vice versa. This stretches and tears cell walls and tiny blood vessels.
• Poor nutrition and hydration: - Skin needs good nutrition to stay healthy and repair itself.
• Loss of sensation: - If you can't feel pain or discomfort, you might not realize the need to change position (e.g., due to nerve damage or spinal cord injury).
• Moisture: - Too much moisture from sweat, urine, or stool can make the skin softer and more prone to breaking down.
• Certain medical conditions: - Conditions that affect blood flow (like diabetes or vascular disease) or make skin more fragile can increase risk.

Individuals who are older, have limited mobility, are very thin or overweight, have poor nutrition, or suffer from conditions affecting blood flow or sensation are most likely to develop pressure ulcers.

When to see a doctor

It's always best to be cautious when it comes to skin changes, especially if you or the person you're caring for is at risk for pressure ulcers.

You should see a doctor or healthcare professional if you notice:

• Any area of skin that stays red (or a different color than usual for your skin tone) for more than 30 minutes after pressure is removed.
• Blisters, cracks, or open sores on the skin.
• Pain, tenderness, warmth, or swelling in an area, especially over a bony prominence.
• Signs of infection: - These are important! Look for pus or watery drainage from a sore, a foul odor, increasing redness or warmth around the sore, fever, or chills.
• If an existing sore seems to be getting larger, deeper, or isn't improving after a few days of trying to relieve pressure.

Don't hesitate to reach out to a healthcare provider. Early attention can make a big difference in how quickly a pressure ulcer heals and can help prevent serious complications. A dermatologist is a specialist in skin conditions and can provide expert diagnosis and guidance.

Frequently Asked Questions (FAQs):

• Q: Are pressure ulcers only a problem for elderly people?
  A: While they are more common in older adults due to factors like thinner skin and reduced mobility, pressure ulcers can affect people of any age who are immobile for long periods or have conditions that put them at risk.
• Q: Can I get a pressure ulcer from just sitting in my office chair all day?
  A: While prolonged sitting isn't great for overall health, it's less common for healthy, mobile individuals to develop pressure ulcers from typical office work because they can shift their weight and get up regularly. The risk is much higher for individuals who cannot easily change positions due to illness or disability.
• Q: If a red spot goes away when I press on it, is it still a concern?
  A: If redness disappears quickly (blanches) when pressed and then returns, it usually means blood flow is still okay. However, if an area stays red and doesn't blanch, especially over a bony area, it's an early warning sign of a possible pressure injury (Stage 1), and you should take steps to relieve pressure from that spot and monitor it closely.
• Q: Are pressure ulcers painful?
  A: They can be, especially in the early stages or if they become infected. However, some individuals with nerve damage or decreased sensation might not feel pain even if they have a severe ulcer.
• Q: Do pressure ulcers always mean someone is not being cared for properly?
  A: Not necessarily. While good care is crucial for prevention, some individuals are at such high risk due to their medical conditions that pressure ulcers can develop even with the best possible care. It's a complex issue.

Sources

• Boyko TV, Longaker MT, Yang GP. Review of the Current Management of Pressure Ulcers. Adv Wound Care (New Rochelle). 2018 Feb 1;7(2):57-67. doi: 10.1089/wound.2016.0697. PMID: 29473024; PMCID: PMC5806543.
• National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2020). Pressure Ulcers. National Institutes of Health. Retrieved from https://www.niams.nih.gov/health-topics/pressure-ulcers
• MedlinePlus. (2021). Pressure ulcers. U.S. National Library of Medicine. Retrieved from https://medlineplus.gov/pressureulcers.html