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What You Should Know About Decubitus Ulcers

What Is a Decubitis Ulcer?

A decubitus ulcer, also known as a pressure ulcer, pressure sore, or bed sore, is an open wound on your skin. Decubitis ulcers often occur on the skin covering bony areas. The most common places for a decubitis ulcer are your:

  • hips
  • back
  • ankles
  • buttocks

This condition is common among:

  • elderly people
  • disabled people
  • people who spend long periods in bed or a wheelchair
  • people who can’t move certain body parts without help
  • people with fragile skin

The condition is highly treatable and recovery is good with proper diagnosis.

Stages of Decubitus Ulcers

Decubitus ulcers occur in stages. The National Pressure Ulcer Advisory Panel (NPUAP) has a staging process to help your doctor diagnose and treat you:

Stage 1

The skin isn’t broken, but it’s discolored. The area may appear red if you have a light complexion. The discoloration may vary from blue to purple if you have a dark complexion. It may appear white.

Stage 2

The skin is open and shows signs of some tissue death around the wound. The ulcer is shallow with a red pink wound bed. There might also be a blister filled with fluid.

Stage 3

The ulcer is much deeper within the skin. It affects your fat layer and looks like a crater. There also might be something that looks like pus in the sore.

Stage 4

Many layers are affected in this stage, including your muscle and bone. A dark substance called "eschar" may be inside the sore.


The ulcer may be yellow or green. It can be soft and look like pus, or it can have a brown scab covering. If the damage to your tissue layers is extensive, it will need to be removed. However, if the covering of the ulcer is dry and stable, it shouldn’t be removed because it’s your body’s natural layer of protection.

What Causes a Decubitus Ulcer?

Pressure is one of the main causes of a decubitus ulcer. Lying on a certain part of your body for long periods may cause your skin to break down. Your skin is thinner in places next to bone or cartilage, and your hips, heels, and tailbone are especially vulnerable to pressure sores.

 Decubitus ulcers can also happen when you scrape or rub your skin against a hard or rough surface. Friction burns on the skin may damage the outermost layer of skin cells, called the "epidermis."

Wearing soiled clothing or undergarments for long periods may create open sores on the skin. This may irritate the delicate outer skin layer.

Who Is at Risk for a Decubitus Ulcer?

There are a number of risk factors for decubitus ulcers:

  • You may be at risk if you can’t move or change positions by yourself while lying in bed or sitting in a wheelchair.
  • Your skin may be more fragile and delicate if you’re an older adult, which can put you at increased risk.
  • Poor eating habits or not getting enough nutrients in your diet may influence the condition of your skin, which can increase your risk. This includes not drinking enough water to keep your skin hydrated and to prevent dryness.
  • Conditions like diabetes may restrict your blood circulation, which can cause tissue destruction in your skin and increase your risk.

What Are the Symptoms of a Decubitus Ulcer?

Each stage of a decubitus ulcer has different symptoms. Depending on the stage, you may have any of the following:

  • skin discoloration
  • pain in the affected area
  • infection
  • open skin
  • skin that doesn’t lighten to the touch
  • skin that is softer or firmer than the surrounding skin

Diagnosing a Decubitus Ulcer

Your doctor may refer you to a wound care team of doctors, specialists, and nurses experienced in treating pressure sores. The team may evaluate your ulcer based on several things. These include:

  • the size and depth of your ulcer
  • the type of tissue directly affected by your ulcer, such as skin, muscle, or bone
  • the color of the skin affected by your ulcer
  • the amount of tissue death that occurs from your ulcer
  • the condition of your ulcer, such as presence of infection, foul odor, and bleeding

Your doctor may take samples of the fluids and tissue in your decubitus ulcer. In addition, they may look for signs of bacteria growth and cancer.

Treating a Decubitus Ulcer

Your treatment will depend on the stage of your ulcer. Treatment can include medications, therapies, and even surgery.

Antibacterial drugs may treat the infection. You may also receive medication to relieve or reduce any discomfort.

A process to remove dead tissue called "debridement" is an option for cleaning your wound.

Keeping the site clean and free of debris is important to promote healing. Your doctor may order frequent dressing changes of your wound.

What Is the Long-Term Outlook?

Your healing process depends on the stage of your ulcer. Treatment is usually less difficult if the ulcer is diagnosed in the first two stages. Your doctor may suggest that you change your diet and increase your fluid intake to help you recover faster. Later stages often require more aggressive treatments and longer recovery times.

Content licensed from:

Written by: Brindles Lee Macon and Matthew Solan
Medically reviewed on: Nov 03, 2015: Debra Sullivan, PhD, MSN, RN

This feature is for informational purposes only and should not be used to replace the care and information received from your health care provider. Please consult a health care professional with any health concerns you may have.
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