By Dr Ananya Mandal, MD
Pressure ulcers may develop in any area of the body. However, areas with the most pressure are often at a higher risk.
Patients admitted to nursing homes with an acute or long term illness and those who are immobile are often at a greater risk of developing pressure sores unless adequate preventive care is taken.
Where are pressure ulcers found?
Common areas where pressure sores are seen are usually over bony prominences and edges. This includes hips, heels, elbows, shoulders, back, ankle and back of the head.
The ulcer varies in size according to the location and the amount of pressure damage.
Early symptoms of pressure ulcers
There are usually symptoms of earlier pressure sores and pressure ulcers. These could be previously healed pressure sore scars or other active un-healed lesions.
Progression of symptoms of pressure ulcers
The ulcer is divided into four stages according to its progression. At the beginning there is erythema of the affected skin. This means the skin is redness over the affected area. When pressed with a gloved finger a normal skin usually blanches as the blood supply to the area recedes and the area turns white.
Stage 1 pressure ulcer
A stage 1 pressure sore does not blanch on pressure with a gloved finger. The skin is still intact and there is no ulceration. The first sign of a pressure ulcer thus is a change in skin colour that may appear slightly redder or darker than usual. Damaged areas will feel warmer than the surrounding skin.
Stage 2 pressure ulcer
Stage 2 involves damage to the skin by formation of an ulcer, a shallow crater or an abrasion or a blister.
Stage 2 may occur due to sliding of the skin and shearing force. This occurs when the affected skin gets trapped between a bony prominence like the lower part of the back bone and the hard bed, wheel chairs or sheets.
Stage 3 pressure ulcer
Stage 3 usually means that the full thickness of the skin is ulcerated. The ulcer gapes as an open wound exposing underlying muscles and tissues.
Stage 4 pressure ulcer
Stage 4 means there is damage to the underlying muscles, joints, nerves, tendons and even the bones.
Other symptoms of pressure ulcers
There may be presence of infection and this leads to exudates, pus formation and bloody discharge from the edges of the lesion. In case of infections local lymph nodes may be affected and may be painfully swollen
There may or may not be pain over the pressure ulcer. In patients with diabetes and other conditions with nerve damage there may be no pain over the ulcer.
The surroundings edges are reddened in most cases.
There might be a track or a channel of pus called a sinus or a fistula. These are usually difficult to treat.
In case of infection there may be a foul odour over the ulcer.
Common features of patients with pressure ulcers
People with pressure sores often have generally poor health. The patient may have a prolonged or severely debilitating disease or injury, poor nutrition status and dehydration, pain and inability to control the bladder and bowel functions.
There may be impaired nerve function and mental health functions, sluggish blood supply to the affected area, edema, lack of movement or paralysis of the area and signs of infection. (1-5)
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)