Dermatology - Pressure Ulcers

Dermatology - Pressure Ulcers 
Pressure ulcers form at the points where the body comes into contact with a surface, such as bony areas, due to external pressure on the skin, as well as forces that cause the skin to slide or rub against another surface. These factors lead to the death of tissue due to reduced blood supply. Bedsores, also referred to as decubitis ulcers, develop in people who are mentally obtunded or have less sensation, such as those with spinal cord disease, in the affected area. Secondary infection leads to the development of cellulitis in a specific area, which can spread to nearby bones or muscles or enter the bloodstream.

Initial symptoms consist of a specific area of redness that becomes pale when pressure is applied. Lesions may or may not exhibit tenderness, and their borders may be indeterminate. 
Stage I: Intact skin shows nonblanching erythema. 
Stage II: Necrosis at this stage affects the outermost layer of the skin (epidermis) and/or the layer beneath it (dermis), resulting in superficial or partial-thickness damage. Bullae progress into dermal necrosis, resulting in the formation of a superficial ulcer. 
Stage III: Severe tissue death, characterized by deep necrosis and the formation of ulcerations with complete loss of skin layers, which can reach the fascia but not penetrate it. 
Stage IV: The complete death of tissue progresses to the formation of an ulcer, affecting underlying structures including muscle and bone, and may increase in size to several centimeters. The presence of purulent discharge and erythema around the ulcer indicates an infection.
An unpleasant smell indicates the presence of an anaerobic infection.

The diagnosis is typically established through clinical means. The differential diagnosis comprises infectious ulcers (such as actinomycotic infection, deep fungal infection, and chronic herpetic ulcer), thermal burns, malignant ulcers, pyoderma gangrenosum, and rectocutaneous fistula.
​
To prevent pressure ulcers, it is important to regularly move bedridden patients every 2 hours, massage areas that are susceptible to pressure ulcers, regularly assess pressure points, and minimize friction and shear forces. The utilization of an air mattress to mitigate compression is advantageous. To address the presence of ulcers, utilize gentle washing agents to maintain cleanliness, ensuring that the skin remains free from urine and feces, while also minimizing contact with moisture. Keep the head of the bed inclined at a modest degree of elevation (<30°).
Assess and rectify the individual's nutritional condition; contemplate the addition of vitamin C and zinc supplements.
Initiate patient mobilization promptly.