Free
E-newsletter
Subscribe to Housecall
Our weekly general interest
e-newsletter keeps you up to date
on a wide variety of health topics.
Mayo Clinic Housecall
Stay up to date on the latest health information.
What you get
- Free weekly e-newsletter
- Mayo Clinic expertise
- Recipes, tools and other helpful information
- We do not share your e-mail address
Symptoms
By Mayo Clinic staff
Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, has defined each stage as follows.
Stage I
The beginning stage of a pressure sore has the following characteristics:
- The skin is intact.
- The skin appears red on people with lighter skin color, and the skin doesn't briefly lighten (blanch) when touched.
- On people with darker skin, there may be no change in the color of the skin, and the skin doesn't blanch when touched. Or the skin may appear ashen, bluish or purple.
- The site may be painful, firm, soft, warmer or cooler compared with the surrounding skin.
Stage II
The stage II ulcer is an open wound:
- The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
- The pressure ulcer may appear as a shallow, pinkish-red, basin-like wound.
- It may also appear as an intact or ruptured fluid-filled blister.
Stage III
At this stage, the ulcer is a deep wound:
- The loss of skin usually exposes some amount of fat.
- The ulcer has a crater-like appearance.
- The bottom of the wound may have some yellowish dead tissue (slough).
- The damage may extend beyond the primary wound below layers of healthy skin.
Stage IV
A stage IV ulcer exhibits large-scale loss of tissue:
- The wound may expose muscle, bone and tendons.
- The bottom of the wound likely contains slough or dark, crusty dead tissue (eschar).
- The damage often extends beyond the primary wound below layers of healthy skin.
Common sites of pressure sores
For people who use a wheelchair, pressure sores often occur on skin over the following sites:
- Tailbone or buttocks
- Shoulder blades and spine
- Backs of arms and legs where they rest against the chair
For people who are confined to a bed, common sites include the following:
- Back or sides of the head
- Rim of the ears
- Shoulders or shoulder blades
- Hip, lower back or tailbone
- Heels, ankles and skin behind the knees
When to see a doctor
Inspection of the skin should be a part of routine nursing or home care for anyone who is confined for a long time to a wheelchair or bed or for anyone who has limited ability to reposition himself or herself. Contact your doctor right away if you notice any signs or symptoms of a pressure ulcer. Get immediate medical care if a person under your care shows signs of infection, such as fever, drainage or foul odor from a sore, or increased heat and redness in the surrounding skin.
- Bluestein D, et al. Pressure ulcers: Prevention, evaluation, and management. American Family Physician. 2008;78:1186.
- Dealey C. Skin care and pressure ulcers. Advances in Skin & Wound Care 2009;22:421.
- Black J, et al. National Pressure Ulcer Advisory Panel's updated pressure ulcer staging system. Dermatology Nursing/Dermatology Nurses' Association 2007;19:343.
- Pressure ulcers. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec10/ch126/ch126a.html. Accessed Jan. 25, 2011.
- Abrams GM. Chronic complications of spinal cord injury. http://www.uptodate.com/home/index.html. Accessed Jan. 28, 2011.
- Dorner B, et al. The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper. Advances in Skin & Wound Care 2009;22:212.
- Langemo DK, et al. Pressure ulcers in individuals receiving palliative care: A National Pressure Ulcer Advisory Panel white paper. Advances in Skin & Wound Care. 2010;23:59.
- Jaul E. Assessment and management of pressure ulcers in the elderly: Current strategies. Drugs & Aging. 2010;27:311.
- Garcia AD. Assessment and management of chronic pressure ulcers in the elderly. The Medical Clinics of North America. 2006;90:928.
- Tleyjeh I. Infectious complications of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2011.
- Berlowitz D. Treatment of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2011.
- Berlowitz D. Prevention of pressure ulcers. http://www.uptodate.com/home/index.html. Accessed Jan. 30, 2011.
Find Mayo Clinic on