Types of Skin Ulcers

Decubitus ulcers develop over areas of skin that are damaged due to long-term pressure against them. As a result, blood flow is restricted, which can then cause skin tissue damage or death (necrosis).

Also known as pressure ulcers or bedsores, these ulcers most commonly occur along bony areas of your body. These include the:

• back
• elbows
• hips
• tailbone
• buttocks
• ankles
• heels

You may be at a higher risk of developing decubitus ulcers if you’re on long-term bedrest or use a wheelchair. Other risk factors include heart disease, neurological diseases, and prolonged anesthesia.

Decubitus ulcers are most common in people ages 70 or older, often due to reduced mobility and aging skin.

Signs and symptoms of decubitus ulcers include:

• pain or tenderness
• swelling
• warmth
• change in skin color
• pus or drainage (if the ulcer bursts open)

Early treatment is critical, as ulcers can lead to long-term damage to the skin, muscle, and underlying bone. Some cases can be fatal. Treatment involves reducing the pressure on the affected area, keeping the ulcer dry, and antibiotics. Surgery may also be necessary.

Venous skin ulcers are the most common type of ulcer that develops on the leg. Experts estimate that more than 60% of all leg ulcers are of the venous subtype.

These develop from weakened skin due to enlarged veins or injuries to the leg. Stasis dermatitis (venous eczema), a skin disease caused by weak blood flow in the legs, can also increase your risk of developing these ulcers.

You may experience:

• pain
• swelling in the leg
• itchiness
• discharge from the ulcer
• hardened or discolored skin surrounding the ulcer

Risk factors for venous skin ulcers include:

• a leg injury
• deep vein thrombosis (DVT)
• varicose veins
• a recent leg surgery or joint replacement
• obesity
• paralysis
• osteoarthritis

You can help prevent the development of venous skin ulcers by exercising regularly, elevating your feet, and wearing compression stockings. Weight loss or management can also help reduce your risk.

If you do have a venous skin ulcer, a doctor may recommend treating it with regular cleanings and dressings. Antibiotics may also be warranted if the ulcer becomes infected. Most cases clear within 6 months, though a small number may never completely heal.

Arterial (ischemic) skin ulcers develop from poor circulation caused by blocked arteries in the lower extremities. These types of ulcers most commonly occur in your feet and legs.

If you have atherosclerosis, you may be at an increased risk of developing arterial skin ulcers. Other risk factors include:

• high blood pressure
• diabetes
• atrial fibrillation

Signs and symptoms include:

• pain, which may worsen at night
• an ulcer that gradually gets larger
• redness and inflammation
• drainage or pus, which could be signs of an infection

Treating arterial skin ulcers primarily involves keeping them clean with frequent dressing changes. If the ulcer becomes infected, you may require antibiotics.

A doctor may also recommend atherosclerosis treatment. Options may include an angioplasty or bypass surgery of the leg to help open up the affected artery and increase blood supply. This can help prevent future ulcers.

Also called diabetic foot ulcers, neuropathic skin ulcers develop in connection with peripheral neuropathy due to diabetes. In such cases, you may experience loss of sensation in the foot along with repeated trauma within the skin that you may not be able to feel.

Risk factors for neuropathic skin ulcers include:

• poor blood glucose management
• high blood pressure (hypertension)
• elevated cholesterol
• overweight or obesity
• smoking

Treatment for diabetic foot ulcers involves protecting the wound with dressings and footwear. Additionally, a doctor will help you get your blood glucose under control.

You may need antibiotics should the ulcer become infected. A doctor may take a culture of the underlying bone if they think the infection has spread. In severe cases, amputation may be required.

Does the type of skin ulcer affect your treatment?

Treatment varies depending on the type of skin, the underlying cause, and its stage. You can treat most skin ulcers by reducing pressure and keeping them clean, reserving antibiotics and surgery for more severe cases.

A doctor may also recommend treating the underlying cause, such as in cases of diabetes, atherosclerosis, or venous insufficiency.

Does the type of skin ulcer affect your outlook?

While the exact prognosis of a skin ulcer varies by type and severity, all types of skin ulcers may become infected if not treated. Severe infections can be fatal in some cases.

What’s the fastest way to heal a skin ulcer?

Keeping the ulcer dry and clean can help it heal and prevent infections. You can do this by dressing the wound with clean wraps and changing them often. Avoiding pressure against the ulcer can also encourage healing.

What is the most common type of skin ulcer?

The prevalence of skin ulcers may depend on where they are on your body. For example, about 60%–80% of leg ulcers are venous ulcers. But a skin ulcer on your back, buttocks, or hips may more likely be a decubitus ulcer.

Can skin ulcers be cancerous?

Common skin ulcers don’t become cancerous. Although rare, one 2021 retrospective review found that doctors can sometimes misdiagnose malignant ulcers as noncancerous chronic skin ulcers, including arterial and venous types.

Skin ulcers are openings in the skin due to injury or underlying chronic conditions. While most ulcers heal on their own, it’s important to report any chronic cases that last longer than a couple of weeks to a doctor. Prompt treatment can help prevent infection in all types of skin ulcers.