Skin Ulcers

An ulcer is a break in the skin that can expose the underlying tissues. Skin ulcers can form for several reasons, such as poor blood circulation, injury, or pressure. This can lead to skin discoloration, swelling, itching, and scanning. It may affect anybody irrespective of age and gender, but they are rarely seen developing in children. People with compromised immune systems or with debilitating diseases like diabetes and hypertension may be more prone to develop a skin ulcer. While most skin ulcers may heal in 1 to 2 days, some may require treatment. Treatment for a skin ulcer usually involves debridement and surgical dressing, but sometimes home remedies can also help. However, remember to consult your doctor before trying any home remedies. Early detection and intervention are crucial since untreated cases can cause complications that may negatively impact your quality of life.

You are at the right place to know more about a skin ulcer, its types, causes, risk factors, symptoms, diagnosis, treatment, and complications! Read on to explore more about skin ulcers. 

What Are Skin Ulcers?

A skin ulcer is a crater-like, open sore on the skin that is roughly circular with an open and raw center. Skin ulcers develop due to the disintegration of tissue around the affected area. There may be a multitude of causes that develop into an ulcer. These ulcers can appear on most of the body parts. However, common areas include the legs, hips, buttocks, feet, and back. Skin ulcers are more likely to affect adults and older people.  

What Are the Types of Skin Ulcers?

There are four main types of skin ulcers, namely:  

Venous Skin Ulcers

• These are shallow ulcers commonly seen in the lower legs due to poor blood circulation.
• Damage to the valves within the leg veins can prevent blood flow back to the heart, causing increased pressure inside the vein that may bulge and eventually break open into ulcers. 

Arterial/Ischemic Skin Ulcers 

• These usually form outside the ankles, feet, and toes.
• They often occur due to an insufficient supply of oxygen-rich blood to the lower limb. 

Neuropathic Skin Ulcers

• These are common complications of uncontrolled diabetes
• High blood sugar levels can damage the nerves, resulting in loss of sensation in the affected area 
• Neuropathic skin ulcers develop from smaller wounds.  

Pressure/Decubitus Ulcers

• Also known as bedsores, they occur due to constant pressure or friction on the skin.
• Increased pressure leads to poor blood circulation, tissue death, and, eventually, ulcer formation. 

How is Skin Ulcer Caused?

Skin ulcers are caused due to poor blood circulation, as seen in the following cases:

Diabetes

• High blood pressure leads to neuropathy (failure to feel any sensation). 
• Since you can't feel pain or pressure, you won't feel injuries to your legs or feet. 

Atherosclerosis

• Here, the arteries become narrow due to increased plaque buildup, resulting in poor circulation. 

Pressure 

• Constant pressure tends to squeeze your old vessels, leading to compression.
• This causes a break in the skin.

Venous insufficiency

• Here, blood cannot be sent back to your heart from your legs, causing blood to pool in the affected vein. 
• As a result of excess pressure, they bulge and break open into an ulcer. 

What Are the Risk Factors Associated with Skin Ulcers?

You are more likely to get skin ulcers due to the following risk factors:

• Pregnancy 
• Limited mobility
• Cigarette smoking
• Increase in age
• Hypertension (high blood pressure)
• High cholesterol
• Obesity (being overweight)
• History of blood clots  

What Are the Symptoms Associated with Skin Ulcers?

Skin ulcers may vary in intensity. They may be minor ulcers affecting the epidermis (superficial skin layer) or major ulcers affecting the dermis (deeper skin layer). 

The symptoms of skin ulcers include:

• Round, crater-like open sore 
• Thick and raised outer borders
• Discoloration of the skin
• Itching and dryness
• Scabbing
• Swelling of the skin near an ulcer 
• Dry or flaky skin around the ulcer
• Pain, soreness, or tenderness near the affected area
• The feeling of warmth in the skin surrounding an ulcer 
• Clear, bloody, or pus-filled discharge 
• Presence of a foul odor 
• Hair loss near the ulcer  

How is Skin Ulcer Diagnosed?

If you notice any skin changes, consult your dermatologist (a doctor specializing in diagnosing and treating conditions related to the skin, hair, and nails) for further evaluation. Your doctor may detect a skin ulcer through the following:

• Medical history
• Physical examination to assess the ulcer and the skin changes around it
• Blood tests to detect the presence of infection 
• Tissue or fluid culture to determine the type of bacteria causing the infection
• Imaging tests like X-ray, CT, and MRI to look for bone involvement  

How is Skin Ulcer Treated?

Treatment for a skin ulcer depends on the type and severity of the ulcer. These include: 

Conservative Approach

• Home remedies and lifestyle changes can help heal a skin ulcer.
• These include
• Compression stockings
• Leg elevation
• Reducing pressure on ulcer-prone areas 
• Maintaining an ideal weight through regular exercises 
• Using natural ingredients like saline water, honey, and turmeric to accelerate healing since they contain anti-inflammatory and antibacterial properties  

Medications

• Topical antibacterial cream
• Oral antibiotics 
• Pain medications to relieve pain and discomfort  

Medical Procedures

• When skin ulcers do not heal through a conservative approach or for more severe skin ulcers, your doctor may suggest medical procedures. These include:

Debridement

• These mechanical procedures remove dead, infected, and damaged tissue from a skin ulcer.

Hyperbaric Oxygen Therapy (HBOT)

• It is a medical procedure where you are given two to three times more oxygen than normal in an enclosed chamber. 
• The oxygen enters your body and heals the wound. 

Surgery

• Surgical intervention is advised to excise the damaged vessel and reroute the blood through healthy vessels.

Skin Grafts

• Deep ulcers that don't heal are treated through skin grafts replacing dead and diseased tissue.

Amputation

• In more severe cases, when skin ulcers don't heal and pose a risk of compromising the function of the affected area, such as the leg or foot, your doctor may amputate a part of the infected area. 

What Are the Complications of Skin Ulcers?

Skin ulcers can develop into chronic wounds and dangerous infections if not treated on time. 

Some complications of untreated skin ulcers include:

• Cellulitis is a bacterial infection affecting deep layers of skin
• Septicaemia, a type of blood poisoning from a bacterial infection
• Infections of the bone and joints
• Gangrene, or tissue death due to poor blood supply 

Conclusion

Skin ulcers are open wound sores that form due to poor blood supply. They mostly occur due to an injury or constant abnormal pressure on any part of your body. They may develop anywhere in your body, but common areas are the legs, hips, buttocks, and feet. Initially, your doctor may try a conservative approach to heal the skin ulcer but may gradually progress to recommend medications. Severe forms of skin ulcers are often treated through medical procedures like debridement, HBOT, surgery, or skin grafts. 

If you have a wound that doesn't heal or notice a skin ulcer, see your doctor immediately for further evaluation.