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.
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
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.
Things that cause
pressure sores include:
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. Skin in this condition may easily develop
a pressure sore.
Treatment focuses on
preventing a sore from getting worse and on making the skin healthy again.
If infection develops, the person will need
antibiotics. Severe pressure sores may need
can help keep skin healthy:
People at greatest risk for getting pressure sores are those who:
Frequently Asked Questions
Learning about pressure sores:
Pressure sores usually develop on the
skin over a
bony area where there is less cushion between the skin and bones. Most
pressure sores develop on the lower part of the body, on the skin over the
sacrum and tailbone (the lowest part of the back), the
hips, buttocks, or heels. Pressure sores also occur on the back of the head,
the backs of ears, around the shoulders and elbows, between the knees, and over
Pressure sores are described in four
In stages 3 and 4 there may be little or no pain due to
significant tissue damage. Serious
complications, such as infection of the bone (osteomyelitis) or blood (sepsis), can
occur if pressure sores progress.
Sometimes a pressure sore does
not fit into one of these stages.
are usually diagnosed with a physical examination.
confirm a diagnosis may include a:
Treatment focuses on preventing
pressure sores from getting worse and on restoring
Steps to treat pressure sores include:
Early treatment can help prevent damage from
pressure sores. After a sore progresses to a more serious
stage, it becomes hard to treat and can lead to
Most stage 1 and stage 2
pressure sores will heal within several weeks with proper treatment. Stage 3 and 4 pressure sores can take months or even years to
heal. Even though progress is slow, continued care and treatment can prevent
complications such as further tissue damage, infection, and pain.
Pressure sores occur most frequently in people who are confined to beds
or chairs. In many cases, a person with a pressure sore also has one or more
medical conditions that may affect treatment and
healing. These conditions include
diabetes, kidney disease, and heart disease.
Relieving and spreading out
pressure is the most important part of preventing and treating pressure sores.
When pressure is in one spot for long periods of time, the blood flow to that
area is decreased. This damages or kills the cells, and creates a sore.
Pressure can be relieved and spread in several ways. Often a combination of
these is best. To relieve and spread pressure:
The basics of
wound care are cleaning, covering, and keeping slightly moist to provide the
best chance for wound healing.
In addition to avoiding
pressure, take steps to protect healthy skin.
Good nutrition is important to
both preventing and treating pressure sores. Focus on getting enough liquids,
calories, protein, and vitamins, and on controlling your weight. Both increases
and decreases in body weight can help cause pressure sores.3 Talk to your doctor or a
registered dietitian about a
healthy diet for you.
Open sores, such as
pressure sores, are easy places for infections to start. Your doctor will be
watching for signs of infection, and you can help watch for these signs. Tell
your doctor if you notice:
To treat an infection, you may use medicine such as
antibiotics, along with special care of the wound. You
and the people around you will also be taught to take steps to keep germs from
spreading to other parts of your body or to other people. These steps include
keeping the sore covered at all times except during treatment, good
hand-washing before and after caring for the pressure sore, and properly
wrapping and throwing away used bandages.
Pain may or may not be a
problem with pressure sores. If you do have pain, talk to your doctor. Some
people with pressure sores do not need any pain medicine, some need pain
medicine just when the sore is being treated, and some need pain control
medicine on a regular schedule.
pressure sores develop when you or a person you are
caring for is hospitalized or confined to a chair or bed. You can take steps to
prevent pressure sores. After a pressure sore has developed, you can help
prevent the sore from getting worse. To prevent or help heal pressure
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CitationsNational Pressure Ulcer Advisory Panel (2007). Pressure ulcer stages. Available online: http://www.npuap.org/pr2.htm.Thomas DR (2003). Management of chronic wounds. In CK Cassel et al., eds. Geriatric Medicine, 4th ed., pp. 967–977. New York: Springer-Verlag.Ho CH, Bogie K (2010). Pressure ulcers. In WR Frontera et al., eds., DeLisa's Physical Medicine and Rehabilitation: Principles and Practice, 5th ed., vol. 2, pp. 1393–1409. Philadelphia: Lippincott Williams and Wilkins.Reddy M (2011). Pressure ulcers, search date June 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.Other Works ConsultedAmerican Medical Directors Association (2008). Pressure Ulcers in the Long-Term Care Setting. Clinical Practice Guideline. Columbia, MD: American Medical Directors Association.European Pressure Ulcer Advisory Panel and National Pressure Ulcer
Advisory Panel (2009). Prevention and Treatment of Pressure Ulcers: Quick Reference
Guide. Washington DC: National Pressure Ulcer Advisory Panel.Hall KE, et al. (2012). Management of common clinical disorders in geriatric patients. In EG Nabel, ed., ACP Medicine, section 8, chap. 2. Hamilton, ON: BC Decker.Ho CH, Bogie K (2010). Pressure ulcers. In WR Frontera et al., eds., DeLisa's Physical Medicine and Rehabilitation: Principles and Practice, 5th ed., vol. 2, pp. 1393–1409. Philadelphia: Lippincott Williams and Wilkins.Hyperbaric oxygen therapy for refractory wounds (2010). Medical Letter on Drugs and Therapeutics, 52(1333): 19–20.Powers JG, et al. (2012). Decubitus (pressure) ulcers. In LA Goldsmith et al., eds., Fitzpatrick's Dermatology in General Medicine, 8th ed., vol. 1, pp. 1121–1129. New York: McGraw-Hill.Reddy M, et al. (2006). Preventing pressure ulcers: A systematic review. JAMA, 296(8): 974–984.Reddy M, et al. (2008). Treatment of pressure ulcers: A systematic review. JAMA, 300(22): 2647–2662.
February 15, 2011
E. Gregory Thompson, MD - Internal Medicine & Margaret Doucette, DO - Physical Medicine and Rehabilitation, Wound Care, Hyperbaric Medicine
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