Pressure Sores

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Topic Overview

What are pressure sores?

A pressure sore (bed sore) is an injury to the skin and/or the tissues under the skin. Constant pressure on an area of skin reduces blood supply to the area. Over time, it can cause the skin to break down and form an open sore (ulcer). Pressure sores are more likely to form if you or a person you are caring for is in the hospital or is confined to a chair or bed.

Pressure sores most often form on the skin over bony areas where there is little cushion between the bone and the skin. Most pressure sores form on the lower part of the body, including over the tailbone and on the back along the spine, on the buttocks, on the hips, and on the heels. Other common spots are the back of the head; the backs of the ears; the shoulders, elbows, and ankles; and between the knees where the legs rub together.

Pressure sores can range from red areas on the surface of the skin to severe tissue damage that goes deep into muscle and bone. These sores are hard to treat and slow to heal. Other problems, such as bone, blood, and skin infections, can develop when pressure sores do not heal properly.

What causes pressure sores?

Things that cause pressure sores include:

• Constant pressure on the skin and tissues. This is by far the most common cause of pressure sores.
• Sliding down in a bed or chair, forcing the skin to fold over itself ("shear force").
• Being pulled across bed sheets or other surfaces (friction burns).
• Moisture that stays on the skin.

As we get older, our skin gets more thin and dry and less elastic, so it is easier to damage. Poor nutrition—common among older people and people who cannot move easily—makes these natural changes in the skin worse.¹ Skin in this condition may easily develop a pressure sore.

How are they treated?

Treatment focuses on preventing a sore from getting worse and on making the skin healthy again. Treatment includes:

• Relieving pressure on the area by changing positions often and spreading body weight evenly with special mattresses or other support.
• Keeping the sore clean and covered, and not letting it dry out.
• Eating a healthy diet with enough protein to help the skin heal.
• Keeping healthy tissue around a pressure sore clean and dry.
• In most cases, removing dead tissue and applying medicated ointments or creams to reduce the risk of infection. Only use medicines prescribed by the doctor to treat pressure sores, and follow all instructions carefully.

If infection develops, the person will need antibiotics. Severe pressure sores may need surgery.

How can you prevent pressure sores?

These steps can help keep skin healthy:

• Prevent constant pressure on any part of the body.
  • Change positions and turn often to help reduce constant pressure on the skin. Learn the proper way to move yourself or a person you are caring for so that you avoid folding and twisting skin layers.
  • Spread body weight. Use pressure-relieving devices or cushions, especially if a person is confined to a bed or chair for any length of time, to help prevent pressure sores. Pad metal parts of a wheelchair to help reduce pressure and friction.
• Eat a healthy diet with enough protein.
• Keep the skin clean and free of body fluids or feces.
• Use skin lotions to keep the skin from drying out and cracking, which makes the skin more likely to get pressure sores. Barrier lotions or creams have ingredients that can act as a shield to help protect the skin from moisture or irritation.

What increases the risk of getting pressure sores?

People at greatest risk for getting pressure sores are those who:^{2 3 4}

• Are confined to a bed or chair, especially if it’s because of a spinal injury.
• Cannot move without help (as with paralysis, coma, or recovering from surgery or injury, such as a hip fracture).
• Cannot control their bladder or bowels. Excess moisture can irritate or soften skin and lead to pressure sores.
• Are not eating a healthy diet with enough protein. Poor nutrition can lead to unhealthy skin and slow healing.
• Are not as alert as normal due to other health problems, from taking certain medicines, or after surgery. People who are not alert and thinking clearly may not understand why preventing pressure sores is important, or they may not be able to take the prevention steps that are needed.
• Are older. As people age, the soft tissue stiffens and is not able to distribute pressure evenly. In addition, skin becomes thinner and less elastic, and injures more easily.¹
• Are smokers. Smoking dries out the skin and reduces blood flow to the skin.
• Have a fever. A higher body temperature puts extra stress on areas of the skin that may already be at risk for pressure sores.
• Have another health problem that makes healing difficult, such as diabetes.

Frequently Asked Questions

Last updated:	March 15, 2007
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	Martin Gabica, MD - Family Medicine, Margaret Doucette, DO - Physical Medicine and Rehabilitation, Wound Care, Hyperbaric Medicine
Editors:	Katy E. Magee, MA, Pat Truman, MATC