Destruction of the skin's surface tissues or the MUCOUS MEMBRANE lining a body cavity such as the stomach or intestine resulting in an open sore (see COLITIS). Usually accompanied by pain and local inflammation, ulcers can be shallow or deep, with a crater-like shape. An ulcer may heal naturally, but on certain parts of the body – legs (venous ulcers, see below) or bony protuberances (decubitus ulcers, see below) – they can become chronic and difficult to treat. When an ulcer heals, granulations (well-vascularised connective tissue) form which become fibrous and draw the edges of the ulcer together. Any damage to the body surface may develop into an ulcer if the causative agent is allowed to persist – for example, contact with a noxious substance or constant pressure on an area of tissue with poor circulation. Treatment of skin ulcers is effected by cleaning the area, regular dry dressings and local or systemic ANTIBIOTICS depending upon the severity of the ulcer.
Also known as pressure or bed sore. Occurs when there is constant pressure on, and inadequate oxygenation of, an area of skin, usually overlying a bony protuberance. Elderly or infirm people, or individuals with debilitating, emaciating or neurological illnesses, are vulnerable to the condition. Long-term pressure from a bed, wheelchair, cast or splint is the usual cause. Loss of skin sensation is a contributory factor, and muscle and bone as well as skin may be affected.
The most important treatment is prevention, keeping the patient's back, buttocks, heels and other pressure-points clean and dry, and regularly changing his or her position. If ulcers do develop, repeated local DEBRIDEMENT, protective dressings and (in serious cases) surgical treatment are required, accompanied by an appropriate antibiotic if infection is persistent.
This occurs on the lower leg or ankle and is caused by chronic HYPERTENSION in the deep leg VEINS, usually the consequences of previous deep vein thrombosis (DVT) – see THROMBOSIS; VEINS, DISEASES OF – which has destroyed the valvular system in the vein(s). The ulcer is usually preceded by chronic OEDEMA, often local eczema (see DERMATITIS), and bleeding into the skin that produces brown staining. Varicose veins may or may not be present. Control of the oedema by compression bandaging and encouragement to walk is central to management.