What Is a Skin Ulcer?

A skin ulcer is a crater-like, open sore on the skin. These wounds are roughly circular, with a center that is open and raw.

Skin ulcers develop when there is a disintegration of tissue. They can be caused by a multitude of different factors, from trauma, lack of circulation, or long-term pressure. Luckily, several treatment options can help to heal skin ulcers and prevent complications.

This article will talk about the various types of skin ulcers, their symptoms and causes, and how they can be treated and prevented.

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."

Skin erodes as ulcer progresses.

Minor skin ulcers are shallow, affecting just the top layers of 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 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.

Types of skin ulcers include:

Venous Skin Ulcers

Venous skin ulcers are the most common types of skin ulcers. They are caused by poor blood circulation in the legs, which allows blood to pool in the veins rather than being sent back to the heart. This condition is known as venous insufficiency.

Venous ulcers are usually shallow wounds; they typically form over a bony area of the leg, such as the ankle. Varicose veins, obesity, lack of activity, and pregnancy all put you at a higher risk for developing these ulcers.

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Decubitus Ulcers

Decubitus ulcers, also called pressure ulcers, pressure sores, or bedsores, 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. If this type of ulcer is not treated promptly, it can worsen to the point where underlying tissues or bone are exposed.

These types of ulcers most often develop around bony areas, since there is less fat there to cushion the skin. They most often occur 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 a bed or in wheelchairs.

Arterial Skin Ulcers

When arteries aren't delivering blood to the skin properly, arterial skin ulcers, also called ischemic ulcers, can develop.

Atherosclerosis is the most common cause of arterial ulcers. Atherosclerosis causes the arteries to narrow, preventing a healthy supply of blood from flowing to the legs and causing skin tissue to die. One of the main causes of atherosclerosis is an unhealthy cholesterol level. Cholesterol creates plaques that build up in the arteries, narrowing them.

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

Neuropathic skin ulcers are most common in people with diabetes. They are often called diabetic foot ulcers.

This type of ulcer can occur when damage to the nerves (neuropathy) causes a loss of sensation in parts of the feet. As a result, you may not 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.

Finger Ulcers

Finger ulcers, also called digital ulcers, are skin ulcerations usually located on the tip or the knucke of a finger. They are often caused by decreased blood flow and poor circulation and most commonly occur in people with an autoimmune disease called scleroderma.

Diagnosis

If you suspect you have a skin ulcer or any wound that isn't healing well, you should see your healthcare provider. 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 healthcare provider can generally diagnose a skin ulcer by simply looking at it. In some cases, they may order an X-ray or computerized tomography (CT) scan to check the ulcer and veins.

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

Of the two, chronic skin ulcers are more serious. Chronic ulcers, even small ones, are prone to infection and can cause a lot of pain.

Differential Diagnosis

There are other types of skin wounds that can resemble ulcers. Your healthcare provider may want to rule these out before making a diagnosis.

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 similar to an ulcer.

Poor-fitting shoes or athletic equipment, or repetitive motions like shoveling, can abrade the skin and leave a crater-like wound.

A large cystic breakout or boil that has drained may also leave 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 healthcare provider.

Treatment

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

Home Remedies

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. Follow your healthcare provider's advice about how to clean the wound and whether you should apply a topical anitibacterial ointment. Cover the ulcer with a bandage to keep it clean and protected.

In most cases, the ulcer will be dressed to protect the wound, and your healthcare provider will show you how to change your dressings at home.

However, if your ulcer is draining considerably, your healthcare provider may recommend leaving the wound uncovered. Dressing the ulcer if it's draining considerably can slow down healing.

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

Restoring good circulation is key in treating and preventing ulcers. This includes elevating the legs, wearing compression stockings, and reducing pressure on ulcer-prone areas. Doing leg exercises prescribed by a physical therapist has also been found to be an effective way of treating venous leg ulcers.

Leg ulcers, in particular, are very likely to reoccur, so you may need to wear compression stockings all the time.

If your ulcers are worsening, especially if you are treating them yourself, don't put off calling a healthcare provider.

Medical Procedures

When an ulcer is not responding to treatment at home, or is getting more severe, medical procedures may be required. These include:

• Debridement: Debridement refers to a variety of mechanical and surgical procedures that may be used to remove dead, infected, or damaged tissue from more serious ulcers.
  
• Hyperbaric oxygen therapy (HBOT): HBOT is a medical treatment in which you sit in an enclosed space filled with pure oxygen, called a hyperbaric oxygen chamber. The air pressure is kept two or three times greater than normal. This allows the body take in more oxygen, which can help heal wounds. HBOT is especially effective for foot ulcers in people with diabetes.
• Surgery: In some cases, venous ulcers may require surgery to remove unhealthy veins from the leg. The blood is diverted through the remaining healthy veins, preventing ulcers from recurring.
• Skin grafts: For deep ulcers or those that aren't healing after a long period of time, skin grafts may be needed to replace dead skin tissue. In the most severe cases, part of the foot, leg, or other appendage may have to be amputated.

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

Prevention

If you're prone to developing skin ulcers, a visit to your healthcare provider is in order. They can help you develop a plan to prevent them.

Eating a healthy, nutritious diet is an important prevention strategy. Nutritional deficiencies can make it harder for the ulcer to heal.

Lifestyle changes are also helpful. Quitting smoking (smoking limits the amount of oxygen in the blood), exercising to increase blood flow, and keeping diabetes and cholesterol levels under control can help prevent ulcers from developing.

A Word From Verywell

Having a skin ulcer, especially a chronic ulcer, can cause constant pain and interfere with your life. Socializing may be difficult because you have a hard time moving around, or are embarrassed by an odor that is coming from your ulcer. These feelings can sometimes result in depression. It's important to let your healthcare provider know if you are feeling depressed.

Always keep your healthcare provider 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.