Decubitus Ulcer


A decubitus ulcer, also called a pressure sore or bed sore, is an open wound on your skin. Pressure sores often occur on the skin covering bony areas. The most common places for a pressure sore to appear includes your hips, back, ankles, and buttocks.

It is common among the elderly, disabled, and other people who spend long periods in bed or a wheelchair, or cannot move certain body parts without help. Decubitus ulcers are also prone to those with fragile skin. The condition is highly treatable and recovery is good with proper diagnosis.

Stages of Decubitus Ulcers

Decubitus ulcers occur in stages. The National Pressure Ulcer Advisory Panel developed a staging process to help your practitioner diagnose and treat pressure sores.

Stage 1

The skin is unbroken, but shows discoloration. If you have a light complexion, the area may appear red. If you have a dark complexion, the discoloration may vary from bluish to purple, or it may appear whitish.

Stage 2

The skin is open and shows signs of some tissue death around the wound. The ulcer is shallow or not too deep.

Stage 3

The ulcer is much deeper within the skin’s tissue (affecting the fat layers) and has the appearance of a crater. A pus-like substance may be present in the sore as well.

Stage 4

This stage affects multiples layers of tissue, including muscle and bone. A dark substance called eschar may be present inside the sore.


The ulcer may have a yellow, brown, or green scab covering it. The damage to the tissue layers is extensive and requires removal.

What Causes a Decubitus Ulcer?

One of the main reasons for a decubitus ulcer to appear on your skin is undue pressure. Lying on a certain area for long periods may cause the skin to break down. Your skin is thinner in places next to bone or cartilage, and your hips, heels, and tailbone are especially vulnerable to pressure sores.

Other causes include the following:


You create friction when you scrape or rub your skin against a hard or rough surface. Friction burns on the skin may damage the epidermis (the outermost layer of cells in your skin).

Urine and Feces

Wearing soiled clothing or undergarments for long periods may create open sores on the skin. This may irritate the delicate outer skin layer.

Who is at Risk for a Decubitus Ulcer?

If you cannot move or change positions by yourself while lying in bed or sitting in a wheelchair, you may be at risk for a pressure ulcer.

Other factors to consider include:


If you are an older adult, your skin may be more fragile and delicate than someone younger.

Poor Nutrition

Poor eating habits or not getting enough nutrients in your diet may influence the condition of your skin. This also includes not drinking enough water to keep your skin hydrated and to prevent dryness.

Medical Problems

Conditions like diabetes may restrict your blood circulation, which may cause tissue destruction in your skin.

What are the Symptoms of a Decubitus Ulcer?

A decubitus ulcer’s symptoms are based on the stage it falls under. Your healthcare provider may look for any of the following:

  • discoloration in the skin
  • pain in the affected area
  • infection
  • open skin
  • skin that does not lighten to the touch
  • skin may be softer or firmer than the surrounding skin

Diagnosing a Decubitus Ulcer

Your regular doctor may refer you to a wound care team of doctors, specialists and nurses experienced in treating pressure sores. The team may evaluate your ulcer based on several important aspects. These include:

  • The size and depth of the ulcer.
  • The type of tissue (skin, muscle, and/or bone) directly affected by the ulcer.
  • The color of the skin affected by the ulcer.
  • The amount of tissue death that occurs from the ulcer.
  • The condition of the ulcer (such as infection, foul odor, and bleeding).

Your physician also may take samples of the fluids and tissue found within the pressure sore. In addition, he or she may look for signs of bacteria growth and cancer.

Treating a Decubitus Ulcer

Treatment involves first properly staging your condition and then developing a wound care plan. This includes medications, therapies, and even surgery to treat pressure sores (or any type of wound).


Antibacterial drugs may be used to treat infection. Pain medication to relieve or reduce any discomfort experienced in your condition also may be prescribed.


Debridement, a process meant to remove dead tissue, may be used to clean your wound.

Other Therapies

Keeping the site clean and free of debris is important to promote healing. Your doctor may order frequent dressing changes of your wound.

What is the Long-Term Outlook?

Your decubitus ulcer’s healing process depends on its stage. If your physician diagnoses your condition in the first or second stages, you have a higher chance for recovery. He or she may change your diet and increase your fluid intake to help you recover faster. Higher stages often require more aggressive treatments and longer recovery time.