Symptoms and Diagnostic Path
The symptoms of decubitus ulcer depend on its
stage of development. Health-care providers clas-
sify decubitus ulcers on a scale of 1 to 4, with
stage 1 being the slightest level of damage and
stage 4, the most significant. PAINis not an effec-
tive measure of a decubitus ulcer’s severity as the
damage to the skin and underlying tissues may
destroy NERVEendings. Doctors diagnose a decubi-
tus ulcer on the basis of its appearance.
Treatment Options and OutlookThe first and most urgent action in treating decu-
bitus ulcers is to relieve all pressure on the area.
This may include using pillows, cushions, pads,
and other items to support the body in positions
that do not put pressure on or near the ulcer.
Additional treatment may include regularly
cleansing the ulcer to prevent INFECTION, or ANTIBI-
OTIC MEDICATIONS to treat infection that already
exists. Deep ulcers (stage 3 and especially stage 4)
often require surgical débridement (removing
dead and damaged tissue under anesthetic).
Recovery depends on the stage of the ulcer and
the general health condition of the person. With
early and aggressive intervention, recovery can be
complete with minimal permanent tissue damage.
Stage 2 and stage 3 ulcers generally heal with
some loss of tissue and scarring. Stage 4 ulcers are
extensive wounds that may require multiple
débridements and long-term treatment by a
WOUND CAREspecialist. When debilitation is long-
term or permanent, the risk for recurring decubi-
tus ulcers is high.
Risk Factors and Preventive MeasuresPeople whose health conditions limit their ability
to move parts of their bodies or confine them to
wheelchairs or bed have very high risk for decubi-
tus ulcers. Preventive measures include
- position changes every two hours when in bed
and every 15 minutes when sitting in a chair or
wheelchair - air mattress with alternating compartments or
air flotation mattress - eggshell mattress or seat cushion
- sheepskin pads over bony protuberances such
as the heels and elbows- active movement at least four times a day
when possible and passive range of motion
exercises when active movement is not possible - frequent (at least daily) inspection of areas vul-
nerable to pressure - diligent skin hygiene, including daily cleansing
and complete drying
- active movement at least four times a day
Prompt intervention at the earliest signs of a
decubitus ulcer can prevent extensive or perma-
nent tissue damage.
See also AGING, INTEGUMENTARY CHANGES THAT
OCCUR WITH; CELLULITIS; EPIDERMOLYSIS BULLOSA; GAN-
GRENE; SCAR; SPINAL CORD INJURY; TRAUMATIC BRAIN
INJURY(TBI).dermabrasion A mechanical method for
smoothing roughened or scarred SKIN. The der-
mabrader is a motorized burrlike device that
“sands” away the layers of skin to achieve the
desired result. Dermabrasion is appropriate for
treating skin blemishes such as ACNEscarring or
sun damage. The dermatologist administers a
sedative and a local anesthetic before the proce-
dure. After the procedure the skin is raw and ten-
der. There is usually significant swelling and
moderate discomfort that requires PAINrelief med-
ication. The skin scabs in about 24 to 36 hours. As
HEALINGprogresses, the scabs fall off, with the new
skin pink and shiny beneath. Total healing is com-
plete in five to six months, though most people
can return to their regular activities in about three
weeks. Risks and complications of dermabrasion
include bleeding, INFECTION, scarring, and occasion-
ally KELOID (overgrown SCAR) formation. Proper
postprocedure care is important to encourage
appropriate healing.
See also BOTULINUM THERAPY; CHEMICAL PEEL; LASER
SKIN RESURFACING; PLASTIC SURGERY.dermatitis INFLAMMATION, redness (erythema),
and itching of the SKIN. Dermatitis has many
causes and manifests in numerous and varied pre-
sentations, some of which may reflect conditions
such as viralINFECTION,AUTOIMMUNE DISORDERS, and
certain kinds of CANCER. Dermatitis may be acute
(come on suddenly) or chronic (persist or recur
over an extended period of time).dermatitis 149