An Overview of Skin Ulcers

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A skin ulcer is a crater-like, open sore on the skin. The wound is roughly circular, the center of which is open and raw. Skin ulcers develop when there is a disintegration of tissue, and are caused by a multitude of different factors, from trauma, lack of circulation, or long-term pressure.

skil ulcer treatments
Illustration by Emily Roberts, Verywell

Symptoms

Skin ulcers cause a crater-like depression in the skin, which may weep clear fluid (called serous), blood, or, when infected, pus. The outer border of a skin ulcer is often raised and inflamed. The skin around the ulcer can be discolored, raised, or thickened. Areas of the ulcer may turn black as the tissue dies.

Skin ulcers generally start slowly and gradually worsen as the skin breaks down. In the early stages of a skin ulcer, you may just notice an area of discoloration, either darker or lighter than the surrounding skin tissue. The area may burn or itch.

As the ulcer progresses, the skin tissue disintegrates and may look like the skin has been eroded away or has "disappeared."

Minor skin ulcers are shallow, affecting just the top layers the skin (the epidermis). More serious skin ulcers can affect the lower layers of the skin (the dermis) and subcutaneous tissue. In extremely severe cases, the ulcer extends to the muscle and bone.

Even small skin ulcers are a cause for concern because they are notoriously slow healers and can easily become infected.

Causes

There are several different types of skin ulcers. Each type of skin ulcer is caused by a different set of underlying factors, but the primary issue is disrupted blood flow.

Anyone at any age can develop skin ulcers, but they are more common in the elderly, people with certain chronic diseases like diabetes and atherosclerosis, and those with mobility issues. Obesity, smoking, and pregnancy also put you at a higher risk. Because skin ulcers are caused by internal factors, they are very likely to reoccur.

Types of skin ulcers include:

Decubitus Ulcers (AKA Pressure Ulcers)

Decubitus ulcers, also called pressure ulcers, pressure sores, or bed sores, are created when there is continued pressure on a particular area of the skin for long periods of time. This compresses the blood vessels, disrupting normal circulation in the area and causing the skin to break down.

These types of ulcers most often develop around bony areas, since there is less fat there to cushion the skin. You'll find them most often on the hips, elbows, back, on the buttocks around the tailbone, and around the ankles and heels. People most at risk for pressure ulcers are those with limited mobility like the elderly, and those confined to bed or in wheelchairs.

Venous Skin Ulcers

Venous skin ulcers are the most common types of skin ulcers. They are caused by poor blood circulation in the legs when blood pools in the veins rather than being sent back to the heart. This leaks into surrounding tissue, causing the tissue to break down. Venous skin ulcers usually form on the lower leg. Varicose veins, obesity, lack of activity, and pregnancy all put you at a higher risk for developing these ulcers.

Arterial Skin Ulcers

When arteries aren't delivering blood to the skin properly, arterial skin ulcers can develop. Like venous ulcers, arterial skin ulcers are more common on the extremities, especially the lower legs. Any condition that compromises your circulation makes you more likely to develop arterial skin ulcers.

Neuropathic Skin Ulcers (AKA Diabetic Foot Ulcers)

Neuropathic skin ulcers are most common in diabetics, so they're often called diabetic foot ulcers. They happen when damage to the nerves causes a loss of sensation in parts of the feet. You won't feel when your feet are tired and need a rest, or if there are small injuries that need to be addressed. Coupled with compromised circulation, these wounds aren't able to heal and, over time, an ulcer develops.

Neuropathic skin ulcers typically form on the bottoms of the feet. Because of the loss of feeling in the foot, these ulcers may not hurt, so they are easy to ignore. As with any ulcer, it's important you treat these as soon as possible, even if they aren't painful enough to be bothersome. Otherwise, they can quickly progress to something more serious.

Ulcer-Like Skin Wounds

These aren't technically skin ulcers because they aren't caused by an internal factor (like lack of circulation) but rather an injury. When the skin has been rubbed away it can leave a crater-like wound that looks rather like an ulcer. Poor fitting shoes or athletic equipment, or repetitive motions like shoveling, can abrade the skin and leave a crater-like wound. After a large cystic breakout or boil has drained, you may have a roundish-shaped area of skin with a depressed center. The good news is that most of these ulcer-like wounds are very superficial and will heal on their own. Deep wounds should be seen by a physician.

Other (Though Uncommon) Causes of Skin Ulcers

Diagnosis

If you suspect you have a skin ulcer or any wound that isn't healing well, you should see your physician. Even minor skin ulcers can progress to something quite serious in a short span of time. Because skin ulcers are notoriously slow to heal, you'll likely need medical advice and intervention to help treat them.

A physician can generally diagnose a skin ulcer by simply looking at it. In some cases, she may order an X-ray or CT scan to check the ulcer and veins.

When you go in to have your skin ulcer examined, your doctor will ask questions about your health and will want to know how long you've had the ulcer, if it's growing or healing, painful, or if it bleeds.

Skin ulcers are classified as either acute or chronic. Acute ulcers are those that heal within about 12 weeks time. Ulcers that are not healing or not healing well after 12 weeks are considered chronic. It's almost as if the skin gets tired of trying to repair the ulcer and decides having a wound is its new normal. Of the two, chronic skin ulcers are obviously more serious. Chronic ulcers, even small ones, are prone to infection and can cause a lot of pain.

Treatment

Treatment for skin ulcers is tailored to your situation and depends largely on the type of ulcer and its severity.

Small superficial ulcers and ulcer-like wounds can generally be treated at home, especially if they are shallow and you don't have an underlying problem that impedes healing. Cover the ulcer with a bandage to keep it clean and protected.

If the ulcer is large or deep, growing in size, incredibly painful, or if you have any signs of infection (increased redness, pain, swelling, and/or pus), you notice a bad smell coming from your ulcer, or you're running a fever, call your doctor right away. You'll also want to call your doctor if your ulcer, no matter how minor, isn't showing signs healing after a week to 10 days.

In most cases, the ulcer will be dressed to protect the wound. However, if your ulcer is draining considerably, your doctor may recommend leaving the wound uncovered. Dressing the ulcer if it's draining considerably can impede healing.

If your ulcer is painful, pain medication can be prescribed. Antibiotics may also be prescribed either prophylactically to prevent infection or to treat an already infected wound.

Debridement is done to remove dead tissue from more serious ulcers. For deep ulcers or those that aren't healing after a long period of time, skin grafts may be needed. In the most severe cases, part of the foot, leg, or other appendage may have to be amputated.

Restoring good circulation is key in treating and preventing ulcers: elevating the legs, wearing compression stockings, reducing pressure on ulcer-prone areas, superficial vein surgery. Leg ulcers, in particular, are incredibly likely to reoccur, so compression stockings are often needed to be worn for life.

Skin ulcers are very slow-healing wounds. Getting them healed properly requires strict adherence to the treatment plan your physician has devised for you, plus time and patience.

A Word From Verywell

If you're prone to developing skin ulcers, a visit to your doctor is in order. He can help you develop a plan to prevent them. One factor you may not consider, but is still an important component to your ulcer treatment, is eating a healthy, nutritious diet. Nutritional deficiencies can make it harder for the ulcer to heal.

Lifestyle changes are also helpful. Quitting smoking, exercising to increase blood flow, losing weight, and keeping diabetes under control can help prevent ulcers from developing.

Having a skin ulcer, especially a chronic ulcer, can interfere with your life. You may be under constant pain. Socializing may be difficult because you have a hard time moving around, or are embarrassed by the odor that is coming from your ulcer. So, be on alert for signs of depression and let your doctor know if you are feeling depressed.

Always keep your physician apprised of any changes in your skin ulcer, ask questions, and do your best to follow your ulcer treatment and prevention plan. This will give you the best possible outcome.

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