What is a decubitus ulcer?

A decubitus ulcer is also known as a pressure ulcer, pressure sore, or bedsore. It’s an open wound on your skin. Decubitus ulcers often occur on the skin covering bony areas. The most common places for a decubitus ulcer are your:

  • hips
  • back
  • ankles
  • buttocks

This condition is common among people who:

  • are older
  • have decreased mobility
  • spend long periods in bed or a wheelchair
  • can’t move certain body parts without help
  • have fragile skin

The condition is treatable, but chronic deep ulcers can be difficult to treat. The specific outlook depends on several factors, including underlying medical conditions as well as the stage of the ulcer.

Each stage of a decubitus ulcer has different symptoms. Depending on the stage, you may have any of the following:

  • skin discoloration
  • pain in the affected area
  • infection
  • open skin
  • skin that doesn’t lighten to the touch
  • skin that’s softer or firmer than the surrounding skin

Decubitus ulcers occur in stages. There’s a staging process to help your healthcare provider diagnose and treat you.

Stage 1

The skin isn’t broken, but it’s discolored. The area may appear red if you have a light complexion. The discoloration may vary from blue to purple if you have a dark complexion. It may also be warm and swollen.

Stage 2

There is breakage in the skin revealing a shallow ulcer or erosion. There might also be a blister filled with fluid.

Stage 3

The ulcer is much deeper within the skin. It affects your fat layer and looks like a crater.

Stage 4

Many layers are affected in this stage, including your muscle and bone.


A dark, hard plaque called eschar may be inside the sore, which makes full evaluation and staging difficult. Sometimes your doctor requires further imaging or surgical evaluation of the area to determine the full extent of the ulcer. The ulcer may also have discolored debris known as slough (yellow, tan, green, or brown), which makes full evaluation difficult.

Prolonged pressure is essentially the main cause of a decubitus ulcer with other factors such as moisture, poor circulation, and poor nutrition contributing. Lying on a certain part of your body for long periods may cause your skin to break down. The areas around the hips, heels, and tailbone are especially vulnerable to pressure sores.

Excessive moisture as well as skin irritants like urine and feces, which result from poor hygiene, can also contribute to decubitus ulcer formation. Friction is also a contributor, such as when a person who is confined to bed has sheets dragged from under them.

There are a number of risk factors for decubitus ulcers:

  • You may be at risk if you can’t move or change positions by yourself while lying in bed or sitting in a wheelchair.
  • Your skin may be more fragile and delicate if you’re an older adult, which can put you at increased risk.
  • Poor eating habits or not getting enough nutrients in your diet may influence the condition of your skin, which can increase your risk.
  • Conditions like diabetes may restrict your blood circulation, which can cause tissue destruction in your skin and increase your risk.

Your healthcare provider 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 things. These include:

  • the size and depth of your ulcer
  • the type of tissue directly affected by your ulcer, such as skin, muscle, or bone
  • the color of the skin affected by your ulcer
  • the amount of tissue death that occurs from your ulcer
  • the condition of your ulcer, such as presence of infection, strong odor, and bleeding

Your healthcare provider may take samples of the fluids and tissue in your decubitus ulcer. In addition, they may look for signs of bacteria growth and cancer.

Your treatment will depend on the stage and condition of your ulcer. Treatment can include:

  • medications
  • local wound care, including specific dressing recommendations
  • lifestyle changes, such as repositioning frequently and using special off-loading cushions, as well as making healthy eating choices
  • treatment of any infection that is present
  • surgery

Antibacterial drugs may treat the infection. You may also receive medication to relieve or reduce any discomfort.

A process to remove dead or infected tissue called debridement may be recommended by your doctor.

Keeping the site clean, dry, and free of irritants is important to promote healing.

Off-loading the pressure as well as frequent repositioning is very important when treating a decubitus ulcer. Reducing friction in the location is also important.

Your healthcare provider may order frequent dressing changes of your wound.

Some therapies are more important for more advanced ulcers (such as surgical debridement and negative pressure wound therapy in stage 3 and 4 ulcers), while all ulcers can benefit from general treatment strategies such as reducing friction and moisture in the area, keeping the area clean, off-loading pressure and repositioning frequently, and improving dietary choices.

Your specific treatment strategy depends on several factors, and your doctor will discuss with you what may be best for your specific ulcer.

Your healing process depends on the stage of your ulcer. The sooner it’s diagnosed, the sooner you can begin treatment and recovery.

Your healthcare provider may suggest that you change your diet. Later stages often require more aggressive treatments and longer recovery times.