Skin Ulcer

Last reviewed by Dr.Mary on October 3rd, 2018.

Skin Ulcers – What are they?

Skin ulcers are open sores which are often painful, and they are commonly accompanied by the sloughing-off of tissue which is inflamed. A vast variety of reasons can develop skin ulcers, for example, trauma, problems with blood circulation, exposure to cold or heat temperatures, or irritation caused by the exposure to various caustic materials.

An individual with a skin ulcer has an open wound in the skin that looks like a crater. Small sores of the skin caused by splints, casts or insect bites will usually heal in a couple of weeks. In individuals with the peripheral vascular disease, these ulcers never heal entirely. Skin ulcers are more common in those with diabetes as well as the elderly. They often lead to infections and may cause serious health consequences.

Skin ulcer Symptoms

Symptoms of ulcers of the skin include:

Open crater in the skin where layers of skin have disappeared
Redness of the skin around the crater
Exposed bone, muscle or tendon

Symptoms of skin ulcers which are infected include:

Pus draining from the skin
Skin pain
Skin bleeding
Skin tenderness
Skin swelling
Red streaks in the skin – Lymphangitis of the arm and Lymphangitis of the back of the legs
Fever

At the start of the formation of an ulcer of the skin, the cells in the area of the body begin to break down and slough away, leaving the area red. Without treatment of the underlying reason for the skin degradation, the erosion of cells may eventually form a blister or bubble of fluid, just beneath the skin. This then breaks open and creates a crater. This crater is the actual skin ulcer and is generally characterized by a perimeter of skin which is surrounding a shiny, depressed center, which can be red, green or yellow depending on how much skin has deteriorated and whether or not an infection has developed.

Skin ulcer Causes

There are many different types of ulcers of the skin. The two most common types include venous skin ulcers which generally affect the feet and the legs and are caused by a reduction in blood flow and therefore swelling. The other common type is pressure ulcers which can be caused by excessive pressure on the skin on any part of the body. Both conditions can cause similar symptoms of itchy and painful reddened or blistered skin and open crater-like sores. Due to the difference in the underlying cause, treatments may vary.

Skin ulcer Stages

Pressure ulcers are classified into four stages depending on the stage of tissue connection, or depth of the sore. The tissue being referred to consists of the skin as well as the basic dermis, fat, bone, muscle and joint. Knowing the correct stage can help in the diagnosis and managing of the ulcer.

Stage I

Nonblanchable erythema of unbroken skin the sign of lesion of skin ulceration. In people with dark skin, discoloration of skin, warmness, edema, induration, or rigidity may be indicators.

Stage II

Limited thickness skin loss concerning dermis, epidermis, or both. The lesion is shallow and presents medically as a blister, abrasion, or shallow center.

Stage III

Total thickness skin loss concerning damage or necrosis of subcutaneous tissue that can expand down to but not thru underlying fascia. The sore at hand medically as a very deep crater with or without undermining of surrounding tissue.

Stage IV

Total thickness skin loss with far-reaching destruction, tissue necrosis or damage to bone, muscle or supporting structures.

Skin ulcer Treatment

Therapy of skin ulcers focuses on reducing pressure against the ulcer and keeping it clean. Treatment for a skin ulcer can include protective bandages or splints, antibiotic cream or ointments, oral antibiotics as well as whirlpool baths. Additional procedures can consist of surgery to remove infected tissue from the ulcer.

Treatment for a skin ulcer may include:

Skin ulcer wound care
Daily gentle cleansing of the ulcer
Whirlpool baths
Protective bandages
Protective splints
Protective pads
Topical antibiotics
Debridement of skin ulcer
Removal of dead tissue from the ulcer
Surgery

Oral antibiotics

Selection can be guided by culturing the skin to identify the organism causing the infection:

Cefepime (Maxipime)
Dicloxacillin (Dycill, Dynapen)
Cephalexin (keflex, Biocef)
Amoxicillin and clavulanate (Augmentin, Augmentin XR)
Clindamycin (Cleocin)
Sulfamethoxazole and trimethoprim (Bactrim, Bactrim DS, Cotrim, Septra, Septra DS)
Ciprofloxacin (Cipro)
Cefazoin (Ancef, Kefzol, Zolicef)
Nafcillin (Unipen)
Ceftazidime (Ceptaz, Fortaz, Tazicef, Tazidime)
Ampicillin and sulbactam (Unasyn)
Imipenem and cilastatin (Primaxin)
Linezolid (Zyvox)
Vancomycin (Lyphocin, Vancocin, Vancoled)
Ertapenem (Invanz)
Metronidazole (Flagyl)
Silver sulfadiazine
Mupirocin (Bactroban)

Skin ulcer Prevention

Following an established skin assessment procedure and treating the patient’s skin accordingly can help reduce the incidence of pressure ulcers for all patients. The following statements have been noted as preventative skin care steps for pressure ulcer preventions:

Cleansing

To prevent bacterial growth and to keep skin free of outside elements, clean the skin with a gentle and mild agent.

Moisturizing

Maintaining proper skin moisture is critical to keeping the epidermis integral and strong. Dry, flaky, or cracked skin boosts the risk of pressure ulcer development.

Incontinent Protection

Incontinence causes the skin to become continually moist and can lead to maceration. Use topical moisture barriers to promote moisture management and minimize skin maceration and friction caused by incontinence.

Skin Fold Management

Skin-to-skin contact areas need to be managed for friction and moisture control.

Other prevention of ulcers of the skin includes:

Avoid foot or leg injuries
Avoid sources of any constant pressure against the skin
Don’t smoke
Keep legs which are swollen elevated as much as possible
Avoid exposure to secondary smoke
Sleep on an egg-crate mattress pad
Clean the skin gently
Change body position frequently while in bed