Skin Ulcers What You need To Know
prompt action can limit serious skin damage
Ulcers or sores are breaks in the skin that last more than three weeks. They can quickly spread outwards, and inwards to deeper tissues. Four-fifths are venous ulcers, which affect one in 500 of us – 1 in 50 over the age of 80. Leg ulcer care is estimated to cost the NHS over
£2.3 billion a year.
Treatment depends on the underlying cause and risk factors, so you may need blood tests for anaemia, diabetes and immune-system problems, swabs for infection and an ultrasound test to see whether your leg arteries are narrowed (peripheral arterial disease – PAD). District nurses can do these tests, and carry out cleaning and dressings. They will refer you back to your doctor or to the Tissue Viability and Leg Ulcer Services if healing is slow or problematic.
Venous ulcers
These are caused by back-pressure from weakened valves inside leg veins, which produces swelling (oedema), discolouration, varicose eczema, and poor skin nutrition. They’re also linked to trauma, varicose veins, deep vein thrombosis, obesity and immobility. They usually form next to the ankle bones, and are shallow and painless with a raw-looking, moist base, but they may become large or infected, with discharge and surrounding cellulitis (redness and pain). They’re treated by elevating the feet, and four-layer graduated compression bandaging (tighter at the ankle than the knee).
Arterial ulcers
Arterial ulcers are linked to peripheral arterial disease, coronary artery disease, strokes, diabetes, obesity and immobility. The reduced supply of blood, oxygen and nutrients means they often affect the feet and toes. You may also notice pale, hairless skin, nail changes or calf pain when walking. They can be very painful, especially at night – hanging legs out of bed can help. If arterial pressure is significantly reduced, ulcers can lead to gangrene and even to amputation, so you’ll be referred to a vascular specialist to see whether you need surgery to replace narrowed artery sections to improve blood flow, or sometimes medication is used. You’ll also need treatment to improve risk factors such as diabetes.
Pressure ulcers and sores
If moving is difficult, pressure or friction can make these develop very quickly – for example, over the hip, bottom or heels. Skin becomes red, blistered and broken, sometimes down to the bone, as underlying tissues become infected or die. Hospitals, care homes and district nurses must carry out risk assessments for medical and other contributory conditions, such as incontinence, poor nutrition and confusion, and arrange regular repositioning and appropriate treatment, including for pain.
Other types of ulcer
Neuropathic ulcers develop when the nerve supply is damaged – for example, the feet in diabetes. They often don’t hurt, so these ‘punchedout’ ulcers may go unnoticed at first. Vasculitic ulcers occur in rheumatoid arthritis and many immune-system disorders. Some forms of skin cancer develop in an existing ulcer, or appear anywhere on the body as a new sore or ulcer that won’t heal. Any new or persistent ulcers should always be assessed by a doctor.