Dermatology

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Bedsores (Pressure Ulcers)

Overview:

They are ulcers appear on parts of the body as a result of prolonged pressure on the skin.
They are common in bedridden persons, who are unable to feel pain or immobility.
Symptoms include unusual changes in skin color or texture.
The degree of damage to skin and tissues can develop to deep injury involving muscles.
Can be prevented by examining the skin regularly, especially bony areas.

Introduction:

It is an ulcer in the outer layer of skin (epidermis) and underlying tissue (dermis) due to prolonged pressure on the skin, and can happen to anyone, but usually affect people confined to bed or wheelchair for long periods of time and often appear in areas with bone spurs, including:

Hips.
Buttocks.
Back.
Tailbone (coccyx).
Ankle.
Heels.
Shoulder.
Back of the head.
Elbows.
Knees.

Other Names:

Pressure ulcers – bed sores.

Causes:

Bedsores are caused by prolonged pressure against the skin that limits blood flow to the skin, which is necessary to deliver oxygen and other substances to the tissues, without which the skin and nearby tissues are damaged and eventually die. Also, friction caused by sliding slowly in the bed or chair, especially if the skin is wet may cause the ulcers.

The Most Vulnerable Group:

People at high risk of developing ulcers are people who have a medical condition that limits their ability to change body positions or spend most of their time in bed or wheelchair.

Risk Factors:

Old age, for lack of skin elasticity and thinning.
Inability to change position easily while seated or sleeping.
Loss of sensation (such as in: spinal cord injuries and others).
Health problems affecting blood flow (such as in: multiple sclerosis, diabetes and others).
Poor nutrition and moisturizing, which maintains the skin health.
Obesity.
Urinary incontinence.

Symptoms:

The ulcer symptoms appear in stages as follows:

First Stage:

The area is red and warm compared to the surrounding skin and may appear blue or purple, and patient may complain of pain, burning, or itching.

Second Stage:

The affected area is damaged with appearance of fluid-filled blisters or an open wound in pink or red color. The patient may complain of pain, in addition to discoloring of the skin around the area.

Third Stage:

The sore looks like a crater (deep wound), damage extends down the layers of the skin, including fats.

Fourth Stage:

These sores are the most serious with the loss of tissues on a large scale. Some may even affect your muscles, ligaments, bones and joints. Infection is also a major risk at this stage.

When to See a Doctor?

If the signs of ulcer on the body do not disappear in 24 to 48 hours after changing your position to relieve the pressure on the area.
If you show signs of infection such as: fever, pus coming from the ulcer and bad smell, or increased redness around it.

Complications:

Cellulitis (is a bacterial infection of the skin and connected soft tissues).
Bone and joint infections.
Squamous cell carcinoma (Marjolin's ulcer).
Blood poisoning.

Diagnosis:

Clinical examination.
Medical history.
Lab screening: blood and urine analysis to assess public health.

Treatment:

Treatment depends on the severity of the case and includes:

Reducing pressure on the affected skin.
Good nutrition.
Caring for the wounds.
Non-steroidal anti-inflammatory drugs to control pain.
Topical or oral antibiotics to control infection.
Surgery to remove damaged tissue and close the wound is sometimes used in the most serious cases.

Prevention:

Change your sitting or sleeping position constantly.
Check your skin daily.
Keep your skin clean and dry.
Wash bedding and make sure they do not wrinkle after placing them on the bed.
Support areas with bone spurs with gel, air or water pads.
Maintain good nutrition and fluid intake.
Maintain healthy weight.
Exercising regularly.
Quitting smoking.

Tips for persons who spend most of their time in a bed or chair:

Reduce pressure on affected area by using special pillow or mattress.
Shift your weight right and left) every 15 minutes.
Raise your upper body, if possible, by pushing on the arms of the chair.
Avoid using doughnut cushions, as they can focus pressure on surrounding tissue.
Change your body position on the bed every two hours.
Ask for help when unable to change your position.
In case of using diaper be sure to dry the area after cleaning off urine and stool.
The ability to feel pain or discomfort can result in being aware of warning signs and the need to change position.

Frequently Asked Questions (FAQs):