These painful ulcers are a potentially serious problem for anyone who is bedridden, confined to a wheelchair, or lacks sensation because of paralysis or some other condition. If a person does not change position every few hours, either independently or with help, blood flow is reduced wherever there is unrelieved pressure. The result is cell death, skin deterioration, and eventually, the development of pressure sores. Places where bone is close to the skin, such as the heels, hips, and base of the spine, are particularly vulnerable.
Diagnostic Studies and Procedures
A bedsore is usually diagnosed by observation. The first warning sign is an area of redness over a pressure point. The skin there gradually thickens and swells, leading to blisters and open sores. Finally, skin ulcerations develop, sometimes becoming progressively deeper until the bone is exposed. At this stage, osteomyelitis, a serious bone inflammation, is likely to develop.
If the source of pressure is identified and corrected at an early stage, bedsores can be treated with special gels, creams, and antibiotics. More advanced bedsores require debridement to remove the dead tissue. Special gels or 1.5 percent hydrogen peroxide may be applied to speed sloughing, so that the diseased tissue can be lifted away with forceps. Deeper sores require surgical removal of damaged tissue and bone. Skin grafts may be needed to cover large areas.
Severe bedsores always require medical treatment. For milder cases, certain homemade remedies can be used, but special care must be taken to avoid infecting open wounds.
Many herbalists recommend myrrh for bedsores because of its astringent and antiseptic properties. Before use, however, it should be tested on a small area of skin to make sure that it does not cause further irritation, and it should never be applied to an open sore.
Wet dressings and special whirlpool baths promote the sloughing of dead tissue. Whirlpool baths also facilitate healing by increasing blood flow to the skin.
poultices of certain natural substances are recommended for the treatment of weeping sores, but if a wound is deep or infected, a health professional should be consulted. A poultice made of raw, unprocessed honey is said to promote healing. So too is a dressing of papaya pulp or a poultice of grated raw or mashed cooked carrots placed on the sore and changed every two to three hours.
To prevent bedsores from developing or from progressing past the initial stages, self care is fundamental. If you are the patient, shift positions frequently and be alert to any red or sore spots. If feasible, exercise in bed to maintain muscle tone and good circulation. This helps to prevent not only bedsores but also the formation of clots that can lead to phlebitis, a pulmonary embolism, or other serious complications. Periodically lift each foot, one at a time, move it in a circle, and flex it up and down. Then lift each leg in turn, without bending your knee, and hold it up for a count of 10 seconds. As strength increases, hold the legs up for longer periods. Knee bends can also be performed while lying in bed, by lifting each leg in turn and flexing and straightening the knee joint. Try to do all of the above exercises four or five times a day, gradually increasing the number of repetitions during each session. In a wheelchair, use a foam rubber cushion covered with sheepskin and raise your buttocks off the seat periodically. Do not sit for extended periods in the same position. If you are caring for someone who is unable to move himself, shift the patient every few hours. Keep the skin clean and dry by washing it thoroughly at least once a day, or more often if the patient is incontinent. Avoid rubbing harshly; gentle sponging with a small amount of soap is best. Pat the skin dry with a soft towel and apply talcum powder where needed. Use a moisturizing lotion to prevent dryness. Change sheets every day or two, or whenever they are soiled or damp. If the patient eats in bed, make sure that all crumbs and food particles are carefully removed after each meal. An egg carton type of foam rubber pad under the bottom sheet can help relieve pressure. A water bed also can help distribute the body’s weight more evenly. Consider using a bed cradle that will keep the covers away from the knees, toes, and heels. For extra protection, sheepskin pads can be used to cushion the heels and elbows, and a larger sheepskin mat can be placed under the buttocks to cushion the hip.
Other Causes of Skin Ulcers
Bacterial infections can lead to skin ulcers, as can varicose veins and other circulatory problems in the legs.