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Skin Ulcer – Pictures, Symptoms, Causes, Stages, Prevention, Treatment

Written by Dr.Mary

Skin Ulcers – What are they?

These are sores which are opened and that are commonly accompanied by the sloughing-off of tissue which are inflamed. Skin ulcers can be developed by a vast variety of events, for example trauma, problems with blood circulation, exposure to cold or heat, or irritation from the exposure to caustic material.

An individual with a skin ulcer has an open wound in the skin that looks like a crater. Small ulcers of the skin caused by splints or casts or insect bites and usually heal in a couple of weeks. In individuals with peripheral vascular disease may have ulcers that never heal completely. Skin ulcers are more common in those with diabetes as well as the elderly. Skin ulcers can become infected and 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 skinLymphangitis 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 forms a crater. This crater is the actual skin ulcer and is normally characterized by a perimeter of skin which is surrounding a shiny, depressed center, which can be red, green and/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 normally affect the feet and the legs and are caused by a reduction of blood flow and therefore swell. The other common type is pressure ulcers which can be caused by excess pressure on the skin on any part of the body. Both conditions can cause similar symptoms of itchy and/or 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 4 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 treatments can include 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 for skin ulcers
  • Protective bandages for skin ulcers
  • Protective splints for skin ulcers
  • Protective pads for skin ulcers
  • Topical antibiotics for skin ulcers
  • Debridement of skin ulcer
  • Removal of dead tissue from the ulcer
  • Surgery for skin ulcers

Oral antibiotics for skin ulcers

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 al patients. The following statements have been noted as preventative skin care steps for pressure ulcer preventions:


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


Maintaining suitable 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

Skin Ulcer Pictures

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