Bedsores: focus

Bedsores (pressure sores) are ulcers on the skin caused by body pressure in bedridden or hypomobile individuals.

Description

When the skin experiences friction or pressure over a prolonged period, ulcers named bedsores can form. The areas where bedsores most often appear are the buttocks, elbows, hips, heels, ankles, shoulders, back and neck.
Bedsores are a common problem in cases of lengthy stays in bed (e.g. due to serious illness) and must be treated appropriately to avoid even more serious infections. Bedsores are also a considerable risk for those: in wheelchairs, with an inability to move certain parts of the body due to conditions such as multiple sclerosis, suffering from diseases that affect blood circulation (e.g., diabetes), suffering from malnutrition, with urinary or bowel incontinence, or with particularly fragile skin.

Causes

When pressure or friction is applied to the skin, the blood flow to the compressed area decreases. This can lead in the long term to the death of tissues in the area, resulting in the formation of bedsores.

Symptoms

The first signs of bedsores are patches of reddened skin that gradually worsen until blisters form and open wounds appear, the color of which varies from purple to brown. The tissue at the base of the ulcer may be covered by yellow, brown or green dead skin.

Diagnosis

Diagnosis of bedsores is based on an observation of the skin’s appearance. During diagnosis, the bedsore will be categorized into one of four stages of severity:

• Stage I: the skin is reddened and when pressed it does not turn white
• Stage II: a blister or open wound is present and the surrounding area may be red or irritated
• Stage III: an actual opening of the skin, called a crater, is present. This indicates damage to the structures underlying the epidermis
• Stage IV: damage involves muscles, bones, and sometimes tendons and joints

Treatment

Treating bedsores requires removing surface pressure from the skin to allow blood circulation to return. Anti-decubitus aids, such as pillows, lifts, polyurethane mattresses and rising beds, etc. can be used to reduce the risk of bedsores from forming in the first place.
Bedsores must be kept clean by following the instructions given by the doctor or nurse.
Typically, bedsores are cleaned with an antiseptic in an aqueous solution. PEG Ointment with allantoin can be used as a healing balm that can be applied both to the fold and to the crater.
The sore should then be covered with breathable cotton gauze. Ensuring the patient has a good, healthy diet will accelerate the healing process.
If pus forms or the bedsore begins to smell unpleasant and/or if the area surrounding the ulcer becomes red or warm, seek medical attention immediately.

Prevention

In cases of prolonged immobility, pay particular attention to areas where pressure sores might form and check them daily.
In general: change position at least every two hours; use anti-decubitus products such as pillows and sheepskins to reduce pressure; apply the soothing, anti-friction Soothing Cream; maintain a healthy, balanced diet and, keep the skin clean and dry.
Further reading: Cutaneous ulcers: the best dressing techniques according to DermaClub