skin disorders
Pressure Sores
Symptoms of Pressure Sores
For most people, pressure sores cause some pain and itching. However, in people whose senses are dulled, even severe sores may be painless. Pressure sores are categorized into four stages (1 to 4) according to the severity of soft-tissue damage. Pressure sores do not always progress from mild to severe stages. Sometimes the first noticeable sign is a stage 3 or 4 sore. Stage 1:On light skin, the skin is red or pink. On dark skin, there may be no changes in skin color. The skin may also be warmer, cooler, firmer, softer, or more tender than nearby skin that is not injured by pressure. At this stage, an actual ulcer is not yet present (the skin is not broken). Stage 2:The pressure sore is shallow with a pink to red base. Some skin may be lost, and blisters may develop. Deeper tissues beneath the sore cannot be seen. Stage 3:The skin over the sore is worn away. The sore sometimes goes down to the layer of fat, but deeper structures beneath the sore, such as muscles and bones, cannot be seen. Stage 4:The skin is worn away all the way through, making the deep structures beneath the sore, such as muscles, tendons, and bones, visible. This photo of a stage 1 pressure sore shows redness but no break in the skin. Photo from Gordian Medical, Inc. dba American Medical Technologies; used with permission. This photo shows a stage 2 pressure sore on the upper right buttock (arrow). Tissues beneath the sore cannot be seen. BOILERSHOT PHOTO/SCIENCE PHOTO LIBRARY This photo shows a stage 3, slowly healing, deep pressure sore on the heel. The tissue has worn through the superficial layer. The darker healing scar hides the deeper tissues. DR P. MARAZZI/SCIENCE PHOTO LIBRARY This photo of a stage 3 pressure sore shows a deeper sore over the base of the spine. Tissues and fat beneath the sore can be seen. DR BARRY SLAVEN/SCIENCE PHOTO LIBRARY This photo of a stage 4 pressure sore shows visible deep structures, such as tendons and the joint. Photo from Gordian Medical, Inc. dba American Medical Technologies; used with permission. Unstageable:Sometimes doctors cannot determine what stage a pressure sore is. For example, pressure sores that are covered with debris or a thick, crusty surface (eschar) cannot be staged unless the debris or eschar is removed. Deep-tissue pressure injury:These injuries are purple- to maroon-colored areas of broken or unbroken skin or blood-filled blisters that are caused by damage to the underlying soft tissues. The area may feel firmer, mushier, warmer, or cooler than surrounding tissue. Medical device–related pressure injury:These injuries result from the use of devices designed and applied for treatment purposes. Long-term use of medical devices, especially if they are poorly placed or ill-fitting, can cause injury to skin or mucous membranes (the moist surfaces or inner linings of some parts of the body). For example, masks or tubing used for people who need oxygen can cause pressure sores on the bridge of the nose, the ears, the back of the head, or wherever the mask or tubing applies pressure. Poorly fitting dentures or an improperly secured endotracheal tube can cause pressure sores inside the mouth. Injuries typically conform to the pattern or shape of the device. Doctors are usually able to determine a stage for medical device–related pressure injuries to the skin but not to the mucous membranes. 