Early Signs of a Pressure Sore

Changes in skin color and temperature offer clues

Personal care assistant chatting to senior woman in bed
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A pressure sore, also known as a bed sore or pressure ulcer, is an area of skin that breaks down when constant pressure and friction is placed against the skin. This breakdown of skin can result in the exposure of the underlying tissue, including bone.

Pressure sores commonly occur in bed-bound people or those confined to a wheelchair. They affect 65 percent of elderly people with a hip fracture and three out of every five quadriplegics. If a sore develops, it can be extremely difficult to treat and may require debridement (the removal of dead tissue) and surgery to repair the damage.

It is for this reason that pressure sores need to be spotted early before dermal rupture occurs (also known as a stage 2 ulceration). By acting fast, you can maintain the integrity of the skin while preventing complications that, in some people, may become life-threatening.

Early Signs and Symptoms

When checking for signs of a developing pressure sore, pay attention to the bony parts of the body where tissues are most likely to be stressed. These include the hip bone, ischium (the curved bone forming the base of each half of the pelvis), sacrum (tailbone), heel, and scalp

Compare the flesh in the bony areas to the surrounding skin, and look for changes in the skin color. Among some of the visual clues:

  • The skin over the areas may appear reddened
  • The skin may not turn white (blanch) when pressed.
  • The skin may be bruised or have a bluish or purplish hue.

Temperature changes may also indicate the early development of a pressure sore. Compared to the skin around the sore, an early pressure ulcer may feel either abnormally warm or abnormally cool to the touch.

Skin consistency may also provide clues. The early stage of a pressure sore may either feel make firm to the touch (as if the skin has suddenly hardened) or feel boggy (as though it is "mushy" or filled with fluid).

Changes in sensation may also accompany. Take note if your loved one complaints about pain, tingling, or itching on any part of the body, even if it's minor.

Prevention

If you notice any of these early warning signs, alert your healthcare provider immediately. If caught early, there are steps you can take to avert a sore before it develops. Among them:

  • Turn your loved one every couple of hours. Doing so alleviates the pressure and friction while restoring circulation to the areas of developing damage. In some cases, you will need pillows or bolsters to keep the person comfortably in place. However, don't wake your loved one in the middle of the night to do so. Rest is important, so wait until he or she is fully awake.
  • Keep the skin dry and clean. The drier the skin is, the less likely it will become boggy and vulnerable to damage. By keeping the skin clean, bacteria are less likely to infiltrate compromised skin. Use a mild soap and soft cloth to wash the skin, ensuring that you don't miss the hard-to-reach spots (such as under the breasts, in the groin, or between the buttocks). To avoid irritation, pat the skin rather than rubbing it dry.
  • Cushion the body with pillows. To reduce moisture and abrasion, place pillows between parts of the body that press against each other. If lying on the back, place pillows under the tailbone, shoulders, heels, and elbows. (Do not place pillows under the knees as it places pressure on the heels). If you are lying on the side, use pillows to separate the knees and ankles.
  • Treat the skin gently. Use moisturizing creams and skin protectants every day to keep the skin supple and prevent flaking or cracking. Avoid talc powders that can be harsh and daily showers or baths that can dry the skin. Ensure the skin is fully clean after a bowel movement or urination, using a squirt bottle to wash the anus, penis, or vagina if needed.
  • Dress your loved one is soft clothes. Avoid clothes that are tight or have thick seams, buttons, or zippers that press against the skin. Make sure the clothes don't bunch up or wrinkle on parts of the body where any pressure is placed on the skin.

Many of the same tips apply if you are wheelchair-bound. Be sure to change positions every 15 to 20 minutes by leaning forward and then side to side. Avoid using a donut pillow which can stretch and stress the skin.

Orthopedic Tools

There are a number of tools you can buy that can also help prevent pressure sores. These include egg-crate mattresses or chair pads that distribute pressure more evenly on the skin. 

Fluidized air mattresses can also reduce the risk of pressure sores. These specialized mattresses are filled with glass beads that liquefy when the air is pumped into them. Although effective, the mattresses are typically reserved for bed-bound patients since moving people in and out of them can be difficult.

There are other types of cushion that work to varying degrees. These include gel pads, natural sheepskin, memory foam, air cell foam, and alternating pressure pads that use an electronic air pump to constantly redistribute pressure on a mattress or cushion. Speak with an orthopedic specialist to determine the best option for your loved one.

A Word From Verywell

If you're still not sure how to spot the early signs that a pressure sore or prevent one from forming, don't hesitate to consult a healthcare professional. They often have pamphlets, illustrations, or other materials that can help you to better identify them before they become a problem.

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