Skin Ulcers – Types, Causes, and Treatment

Overview

Skin ulcers are round, crater-like, open wounds that develop on the skin due to poor blood circulation or injury. These roughly circular and raw sores can form on any body area and take longer to heal. While mild skin ulcers are not necessarily dangerous, they become severe if untreated. Following the infection, skin ulcers may spread deep inside the tissues and require immediate medical attention.

The fact that skin ulcers affect older adults and the older population brings the seriousness of this condition to the forefront. A skin ulcer usually appears on the hips, feet, legs, and back. 

This article delves into the various types of skin ulcers, symptoms and risk factors, along with preventive measures.

Identifying Skin Ulcers

Skin ulcers typically develop when there is tissue disintegration and can be caused by many factors, such as lack of circulation, trauma, or long-term pressure. 

The sore’s outer border might look thick and raised. As the ulcer forms, skin discolouration appears in that specific area. It looks red and warm. As the condition worsens and the tissue dies, it looks like a crater and begins to weep clear fluid or blood in the bones and joints.

Depending on the type of ulcer you have, you may notice the following signs and symptoms:

• Itchiness
• Skin texture changes
• Green or yellow pus due to an infection
• Pain and swelling
• Redness
• Raised and inflamed borders

What causes skin ulcers?

Anyone at any age can have skin ulcers, but these are prevalent in older adults, people with certain chronic diseases such as diabetes and atherosclerosis, and people with mobility issues.

Obesity, pregnancy, and smoking put you at a higher risk. There are a couple of underlying causes that lead to poor blood circulation, which include:

1. Diabetes

Diabetes is responsible for elevated levels of blood sugar, which in turn can result in a condition known as peripheral neuropathy characterized by nerve damage. Individuals afflicted with peripheral neuropathy may experience a loss of sensation in their legs and feet. Consequently, injuries or pain in these areas may go unnoticed due to the absence of feeling. Moreover, high blood sugar can impede the healing process of wounds. If left untreated, this combination of factors creates an ideal environment for developing skin ulcers.

2. Atherosclerosis

When plaque accumulates in the arteries, it leads to plaque formation. This plaque causes a significant narrowing of the arteries, known as Atherosclerosis or arteriosclerosis. Arteries play a crucial role in delivering blood throughout the body. However, they cannot circulate blood effectively when they become too narrow. Insufficient blood supply to a particular body part can break the skin tissue and cause a sore to form, which may rapidly progress into a skin ulcer. Individuals with diabetes can develop atherosclerosis.

3. Friction or Pressure

Prolonged immobility can develop skin ulcers due to the constant pressure on affected areas, which can cause blood vessels to constrict and impede healthy blood flow to the skin tissue. This can result in tissue death and the formation of ulcers, similar to the effects of atherosclerosis.

4. Venous insufficiency

Venous insufficiency occurs when the veins in your legs are unable to effectively transport blood back to your heart. As a result, blood accumulates in the legs, causing swelling. In more severe cases, this swelling can exert pressure on the skin, resulting in ulcers. Varicose veins and blood clots are the primary factors contributing to venous insufficiency.

Risk factors and complications of skin ulcers

If you have the following risk factors, you are most likely to get skin ulcers:

Pregnancy: Pregnancy can lead to leg vein problems due to hormonal changes and increased blood volume. 

Age: As we age, we become more susceptible to atherosclerosis and venous insufficiency. 

Smoking: Smoking cigarettes can also have adverse effects on blood flow by hardening arteries.

Limited mobility: Due to being bedridden, paralyzed, or using a wheelchair it can put constant pressure on the skin and restrict movement. 

Hypertension: High blood pressure and high cholesterol can damage arteries and disrupt blood flow. 

Obesity: Obesity increases the risk of diabetes, atherosclerosis, and elevated pressure in the leg veins. 

Blood clots: Finally, a history of blood clots can contribute to blood flow issues.

If a skin ulcer is not treated, it has the potential to become infected, which can result in a prolonged healing process. Additionally, the infection can spread to deeper tissues, bones, joints, and even the bloodstream.

Types of skin ulcers

A skin ulcer is a breakage or opening of your skin and mostly heals within 1 or 2 weeks without medical intervention. However, in some cases, it turns out to be complicated with life-threatening infections. 

There are four types of skin ulcers with different causes and symptoms, such as:

1. Pressure Skin Ulcers

Also called Decubitus ulcers/ bedsores/ pressure sores, pressure skin ulcers are primarily caused by continuous or long-term pressure on a specific skin area. The compression of blood vessels leads to the disruption of regular blood flow in the affected area, resulting in skin breakdown. Failure to promptly treat this particular ulcer can lead to its deterioration, potentially exposing underlying tissues or bone.

Skin tissues generally withstand a maximum mercury pressure of 30-32 millimetres. Any pressure increase beyond the given range leads to tissue death and poor circulation, forming ulcers.

Pressure ulcers develop on bony parts of the body such as elbows, back, tailbone, hips, and ankles. In their most severe stage, these ulcers can be so deep that they damage the bones, muscles, tendons, and joints.

Other risk factors for pressure ulcers include neurological diseases, heart diseases, and prolonged anaesthesia. Treatment involves keeping the ulcer dry, reducing the pressure on the affected area, and using antibiotics. In some cases, surgery may also be necessary.

2. Arterial Skin Ulcers

An arterial ulcer, also referred to as an ischemic ulcer, can occur when there is a decrease in blood flow to the feet or legs, typically caused by damage to the arteries. Any condition that affects your circulation increases the risk of developing arterial skin ulcers. These ulcers commonly appear on the legs, ankles, toes, and even between the toes. 

The wound may have a raised edge, and the sore can exhibit various colours, such as dark red, yellow, grey, or black. Arterial ulcers develop when the arteries fail to provide sufficient oxygen-rich blood to the lower limbs. As a result, tissues die, pain develops, and an ulcer develops without a steady oxygen supply.

3. Venous Skin Ulcers

Venous skin ulcers are prevalent on the leg and are considered the most common type. Over 60% of leg ulcers are estimated to fall under the venous subtype. These ulcers occur due to weakened skin caused by either enlarged veins or leg injuries. 

Additionally, individuals with stasis dermatitis (venous eczema), a skin condition caused by poor blood flow in the legs, are at a higher risk of developing these ulcers.

4. Neuropathic Skin Ulcers

Neuropathic skin ulcers are commonly found in individuals who have diabetes. They are frequently referred to as diabetic foot ulcers. These ulcers can occur when nerve damage, known as neuropathy, leads to a loss of sensation in some regions of the feet. Consequently, you may need to be made aware when your feet are tired and require rest or if minor injuries need attention. 

Typically, neuropathic skin ulcers form on the soles of the feet. Due to the lack of sensation in the foot, these ulcers may not cause pain, making them easy to overlook. 

Like any ulcer, it is crucial to promptly treat neuropathic skin ulcers, even if they are not painful enough to cause significant discomfort. Otherwise, they can rapidly progress into a more severe condition.

Diagnosis of skin ulcers

Following are the different tests that a doctor performs to diagnose a skin sore. It includes:

• Physical examination
• Fluid or tissue culture
• Medical history and records
• Blood and imaging tests such as an X-ray or CT scan

Treatment options

Skin ulcers take time to heal, so having the right plan can efficiently help the treatment process. The treatment methods differ slightly depending on the severity and type of ulcer. 

Here are some of the treatment options and healing techniques that one can choose for curing skin ulcers and restoring good blood circulation:

• Using honey, saline solution, and turmeric to clean the skin wounds
• Dressing the ulcer wounds to keep it moist and infection-free
• Taking medications and antibiotics to manage pain
• Undergoing medical procedures such as debridement, amputation, skin graft, or surgery
• Wearing compression sleeves or tights
• Reducing pressure with the use of foam cushions or mattress pads
• Maintaining a healthy body weight with regular exercise

Preventive measures

Getting skin ulcers to heal appropriately will require strict adherence to the treatment techniques and patience. If you are prone to developing skin ulcers, consult a healthcare provider immediately and sketch a plan. Here are some of the preventive care that one can follow to heal skin ulcers:

• Eat a nutritious diet and change your lifestyle habits
• Keep diabetes and cholesterol levels stable
• Avoid sitting or standing for a long time
• Protect your feet from cold and avoid walking barefoot
• Exercise to have healthy blood flow

Wrapping up

There are various kinds of skin ulcers, and each type may require different prevention or treatment methods. 

Once you or someone you care about observes the development of an ulcer, it is crucial to initiate treatment promptly. Timely treatment can help avoid complications arising from the ulcer.

Talk to your healthcare provider frequently and follow the prevention plan accordingly for faster recovery of wounds.

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