Pressure ulcers


Pressure ulcers (also known as bedsores or pressure sores) are open wounds that develop on the skin due to prolonged pressure on the skin. They are most often found on skin that is subjected to constant pressure, such as the elbows, heels and hips. Pressure ulcers can be classified into four stages, ranging from Stage I – a reddened area of skin to Stage IV – a deep wound with extensive damage and possible infection. Management of pressure ulcers is important for reducing the risk of complications and treating existing wounds. Typical treatments include boosting nutrition, wound care and protection of vulnerable areas, changing positions regularly and using specialized cushions and mattresses.


The most common symptoms of pressure ulcers include red discoloration of the skin, swelling, tenderness, persistent skin lesions, and areas of broken skin. In some cases, the skin may be discolored purple or black, may ooze fluid or pus, and may have a foul odor. In more severe cases, the ulcer may extend deeper into the tissue, causing significant pain and even bone or joint damage. Other symptoms may include fever, chills, loss of skin sensation, and a decrease in mobility.


The most common known cause of pressure ulcers is prolonged pressure on the skin, typically from a combination of body weight, moisture, and friction. Other risk factors include immobility, lack of nutrition, poor circulation, age, and residence in a nursing home or long-term care facility. Medical conditions and medications can also increase the risk of pressure ulcers.

Risk factors

Pressure ulcers are caused by a lack of adequate pressure relief on specific areas of the body, which can cause tissue damage and tissue death. The main risk factors for pressure ulcers can be divided into intrinsic risk factors, which are within the individual, and extrinsic risk factors, which are external to the individual.

Intrinsic Risk Factors:

  • Age: Elderly individuals, especially those over 85, are more at risk for pressure ulcers.
  • Poor Nutrition: Malnutrition increases the risk of pressure ulcers by leading to weakened skin and muscle tone.
  • Limited Mobility/Immobility: Individuals who cannot move or who cannot move very well on their own are more likely to experience a pressure ulcer.
  • Medical Conditions: Certain medical conditions, such as diabetes, infections, and HIV, can increase the risk of pressure ulcers.
  • Reduced Sensation: Individuals who have reduced sensation in the affected area are more prone to developing pressure ulcers.

Extrinsic Risk Factors:

  • Incontinence: Moisture due to incontinence can further damage the skin and increase the risk of a pressure ulcer.
  • Environment: Limited access to medical care and inadequate positioning in bed or chair can increase the risk of pressure ulcers.
  • Equipment: Poorly fitting medical equipment, such as wheelchairs and braces, can cause friction on the skin and lead to pressure ulcers.
  • Uncomfortable Surfaces: Hard surfaces, such as steel or metal beds, can increase the risk of pressure ulcers.


Pressure ulcers are typically diagnosed through a physical examination, during which the doctor will note any areas of discoloration, swelling, drainage, or tenderness on the skin. They may also perform a biopsy (sampling of tissue) to determine the extent of the injury and to help rule out other skin conditions. The doctor may also review the patient’s medical history, evaluate risk factors, and ask questions about the patient’s lifestyle. In some cases, imaging tests such as X-rays or an MRI may be necessary to determine the severity of the condition.


Pressure ulcers can be divided into four main subtypes, which are:

  1. Stage I: These are the mildest pressure ulcers, usually defined as redness in areas that are usually unaffected by pressure. At this stage, the pressure ulcer is still superficial and heals quickly.
  2. Stage II: These pressure ulcers are deeper, resulting in a superficial skin loss, but no necrosis or damage to the underlying tissue.
  3. Stage III: These pressure ulcers have the deepest level of tissue injury and can involve fat, muscle, and even bone.
  4. Stage IV: The most serious stage of pressure ulcers, these involve full-thickness tissue loss and may even expose underlying structures, such as bone or tendons.


Treatment options for pressure ulcers may include:

  1. Wound dressings: Applying special dressings such as hydrocolloid dressings, foam dressings, alginate dressings, or other special wound care products that are designed to provide a moist wound healing environment and promote natural healing.
  2. Surgical debridement: Removing necrotic tissue and other foreign material from the wound to promote wound healing.
  3. Skin grafting: Using a healthy piece of skin from a donor to cover the wound.
  4. Specialized topical creams or ointments: These may be used to reduce inflammation, promote wound healing, and reduce the risk of infection.
  5. Nutritional supplements and medications: These may be prescribed to ensure adequate nutrition and improve wound healing.
  6. Off-loading: Reducing the pressure on the wound through the use of special devices, braces, or other supports.
  7. Specialized compression therapies: Using wraps or socks filled with air or foam to provide compression therapy to the wound.
  8. Hyperbaric oxygen therapy (HBOT): This therapy helps wounds heal by delivering high-pressure oxygen directly to the wound site, encouraging the growth of new blood vessels and providing oxygen to damaged tissue.


  1. Keep the skin clean and moisturized, especially in areas where contact with skin is most likely.
  2. Position the body frequently, at least every two hours, using a good support cushion when sitting.
  3. Avoid lying or sitting in the same position for extended periods of time.
  4. Use a soft, low-friction mattress or other specialized pressure-relieving surface.
  5. Choose bedding and clothing that is comfortable and breathable.
  6. Make sure skin temperature is regulated and avoid direct contact with heat sources.
  7. Avoid contact with anything that is too tight or abrasive which may cause skin breakdown.
  8. Make sure nutrition and hydration are adequate, as inadequate nutrition and hydration increase risk of pressure ulcers.
  9. Have periodic assessments of skin integrity, including observation for the early signs of pressure ulcers.

Gender differences?

Yes, there are gender-specific differences in the presentation and management of pressure ulcers. Women generally experience pressure ulcers more often than men, and the location of the ulcer is different between the two sexes. Women generally develop pressure ulcers on the sacrum, trochanter, ischial tuberosity, and heel, while men tend to develop them on the occiput, scapula, and heels. Women also experience greater severity of pressure ulcers and longer healing times than men.

Additionally, women are more likely to suffer from comorbidities associated with pressure ulcer development, such as arthritis, diabetes, and obesity, which can interfere with pressure ulcer healing. Women may also have different skin characteristics than men, such as thinner skin, which can contribute to faster development and slower healing of pressure ulcers. In addition, women may have different nutritional needs than men, which can affect the management of the pressure ulcer. Finally, women may have different social care needs than men due to cultural or religious reasons, so the care plan must be tailored to their individual needs.


Nutrition plays an important role in the management of pressure ulcers. Proper nutrition is essential to help maintain the skin’s integrity and to aid in the healing process. Dietary goals for individuals with pressure ulcers should include obtaining adequate calories, proteins, and essential fatty acids. Additionally, fluid and electrolyte intake should be monitored to ensure hydration and reduce risk of infection. Supplements such as zinc, copper, and vitamin C may also be necessary for proper healing. Nutrition also assists in maintaining overall body health, which can be beneficial in the healing process. Lastly, a healthy balanced diet that includes fruits and vegetables, as well as lean proteins may help to strengthen the immune system, reduce inflammation and support healthy skin.

Physical Activity

Physical activity can impact the development and progression of pressure ulcers. It can help to improve circulation, reduce tissue trauma or damage, improve range of motion, and support better nutrition and hydration, which can speed up healing. Recent studies have shown that physical activity can also improve skin integrity and reduce the risk of developing a pressure ulcer. Physical activity improves blood flow throughout the body, including to the skin, bringing nutrients and oxygen to the skin that helps promote healing and reduce the risk of tissue damage. Additionally, exercise can reduce skin deformation, which helps to reduce the risk of forming a pressure ulcer. In conclusion, physical activity can have a positive effect on pressure ulcers by improving circulation, reducing tissue trauma, improving range of motion, and providing better nutrition and hydration.

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