Skin ulcers: Types, Symptoms, Causes, Diagnosis, Complications, Treatment and Prevention

Skin ulcers are painful, open sores or wounds that keep returning or don't heal properly.

Updated: October 30, 2019

Skin ulcers are painful, open sores or wounds that keep returning or don't heal properly. Skin ulcers often occurs because of poor blood circulation. However these can be caused by various events, such as being bed or on wheelchair. These can cause pressure on blood circulation which may lead to skin ulcers. Usually ulcers are round in shape and the affected areas will be red, swollen, thickened skin around. They are often very slow to heal. Skin ulcers are often accompanied by the sloughing-off of inflamed tissue. Left untreated skin ulcers may become infected and the infection may spread causing many serious health issues.

Types of Skin Ulcer:

There are various types of skin ulcers that include:

Venous Ulcers:

A venous skin ulcer is a sore on your leg, usually because of weak blood circulation in the limb. The poor circulation from the legs back to the heart also called as venous insufficiency causes blood to back up in the vein and then seep out into the surrounding tissues. The veins in the leg, which should send blood back to the heart would not be working properly. As a result the tissues break down and cause painful ulcers to form. The back flow of blood increases pressure in the end of the limb which can weaken the skin and make it harder for a cut or scrape to heal. They often occur over bony areas, such as your ankle and are very slow to heal.
You also may have a chance of getting it if you:

  • Have previous leg injuries
  • Have varicose veins
  • Are obese
  • Smoke
  • Have had other circulation problems such as blood clots or phlebitis, a painful swelling of the veins

A venous ulcer often feels itchy or burns, and the leg around it may be swollen. Other signs may include a rash or dry skin and brownish discoloration. The base of a venous ulcer is typically red and covered with a yellow film. These sores often weep clear fluid, but might ooze yellow or green discharge if the ulcer is infected. A foul-smelling fluid oozing from the sore can also be there. A redness or swelling of the surrounding skin with pus, fever and worsening pain are the symptoms when the ulcer is infected.

Pressure Ulcers:

Pressure ulcers, commonly called bed sores are caused by staying in the same position for long periods. These are most commonly seen in people who are confined to bed or a wheelchair. Individuals who are bound to a wheelchair often develop bed sores on their buttocks. The non-movement cuts off blood circulation, and the lack of adequate blood flow kills the tissue in that area because of prolonged pressure to a spot on the skin. These skin ulcers are commonly found where the bones are close to the skin, such as the heels, ankles, elbows, hips and back.

Neuropathic Ulcers:

Individuals with diabetic who have suffered from nerve damage in the feet, usually develop neuropathic ulcer. Local paresthesias, or lack of sensation, over pressure points on the foot leads to extended microtrauma, breakdown of overlying tissue, and eventually ulceration. In addition, neuropathy can result in minor scrapes or cuts failing to be properly treated which eventually developed into ulcers. These skin ulcers typically develop at the pressure points on the bottom of the foot and are caused by sustained high pressure due to impaired blood circulation. Usually, peripheral neuropathy affects the sensory nerves which are responsible for detecting sensations such as temperature or pain. However, it can also affect the motor nerves responsible for the contraction of muscles. Damage to motor nerves can cause minor muscle wasting, resulting in the imbalance of flexor and extensor muscles to cause foot deformities, such as claw toes or the end of the long foot bone that is closest to the toe joint. This then provides additional pressure points prone to ulceration. Ulceration on the side of the foot develops as a result of poor-fitting footwear, whereas ulceration on the top of the foot is typically due to trauma.
These ulcer appears as pinkish-red or a brownish-black color. The surrounding skin is frequently calloused. The depth of the wound depends on the thickness of the callous. Often there will be undermining in the wound, or underlying pockets of infection, which can in turn lead to infection of the bone or bone marrow called osteomyelitis if left untreated. The wound itself will be painless unless there is also infection or an arterial component to the ulcer.
A primary neurological condition, diabetes, renal failure, trauma and surgery may be the cause of repeated stress on feet resulting in neuropathic ulcer. Some less common conditions that can lead to neuropathic ulcers are chronic leprosy, spina bifida, and syringomyelia. Diabetics can reduce the chance of developing neuropathic ulcers by keeping their blood sugar in control, wearing shoes that fit properly and examining their feet for sores on a regular basis.

Arterial Ulcers:

Arterial ulcers typically occur in patients who are suffering from artery disease. Arterial ulcers, also referred to as ischemic ulcers, are caused by poor circulation of nutrient rich blood to the lower extremities. As a result the overlying skin and tissues are deprived of oxygen, killing these tissues and causing the area to form an open wound. In addition, the lack of blood supply can result in minor scrapes or cuts failing to heal and eventually developing into ulcers.
The arteries are responsible for carrying nutrient and oxygen rich blood to the various tissues in the body. But when the blood supply is restricted, this can cause narrowing of the artery or damage to the small blood vessels in the extremities leading to arterial ulcers. This type of skin ulcer typically occurs on the areas, where the poorly functioning arteries have trouble circulating blood properly such as feet, toes and toenails.
The base of an arterial ulcer has a brown, yellow, black or gray color, while the surrounding skin often looks red and swollen. These ulcers are generally very painful, especially while exercising, at rest, or during the night. A common source of temporary relief from this pain is dangling the affected legs over the edge of bed, allowing gravity to aid blood flow to the ulcerous region.

Symptoms of Skin Ulcer:

The most common symptoms for all type of skin ulcer include:

  • Reddish area on the skin
  • Skin color and texture changes
  • Swelling
  • Pain
  • Wound that isn't healing
  • Crater in the skin
  • Drainage or pus

Causes of Skin Ulcer:

There are many causes of skin ulcers. Some of these include:

  • Decreased blood flow to a part of the skin or vascular insufficiency
  • Trauma
  • Lack of movement of a part of the body for long periods of time
  • Infection
  • Poor hygiene
  • Varicose veins
  • Chronic vascular insufficiency
  • Vasculitis (inflammatory damage of blood vessels)
  • Diabetes mellitus
  • Renal failure
  • High blood pressure
  • Arteriosclerosis (hardening of the arteries)
  • Atherosclerosis (thickening of the arteries, due to the buildup of fatty materials)
  • Limited joint mobility
  • Increased age
  • Vitamin deficiency

Diagnosis of Skin Ulcer:

If you have a wound that isn't healing or you think is infected, you should see your doctor. You should call your doctor immediately if any of these occur:

  • Fever of 100.4  degree F or higher
  • Signs of infection. These include increasing pain, warmth, redness, or pus draining from the skin ulcer.
  • Bleeding from the skin ulcer
  • Pain in or around the ulcer that doesn't get better even with medicines
  • Increased swelling
  • Changes in skin color

Your doctor will ask you if you have a history of ongoing or chronic conditions, such as diabetes or hardening of the arteries. These are the conditions which can lead to either neuropathic ulcer or arterial ulcer. Sometimes an X-ray or a CT scan can also be ordered by your doctor to check out your veins and the area around the ulcer in more detail.

Complications of Skin Ulcer:

An ulcer can lead to serious skin and bone infections. The infection of the bone or bone marrow is called osteomyelitis. It can give rise to skin cancer in rare cases.
Arterial ulcers can lead to serious complications, including infection, tissue necrosis, and in extreme cases amputation of the affected limb.

Treatment of Skin Ulcer:

The most common treatment for skin ulcer is a compression bandage or stocking. The pressure will improve the blood circulation in your leg, boosting your body's ability to heal the sore. The most effective treatment for venous skin ulcers is the frequent elevation of the legs above the level of the heart. You can raise your leg for set lengths of time as well. This also helps circulation of blood.  Half an hour at a time, up to 3 or 4 times a day is typically recommended for quick healing.
Sometimes vein surgery or skin grafting is required for venous ulcers if it gets infected. Antibiotics can be used to kill the infection if your ulcer is infected by bacteria.
You might also be given a moist dressing to put over the ulcer to help it heal more quickly. Patients with severe arterial ulcers might need bypass surgery or endovascular therapy to restore circulation to the legs and feet.This can help your ulcer heal and could prevent similar problems later.
One of the most essential components to effectively healing neuropathic ulcers is to reduce pressure on the affected area. Excessive bed rest is not recommended as relieving pressure from the wound needs to be balanced with keeping proper circulation to the extremities. Therapeutic shoes are also available to decrease pressure of the affected. Surgery may be considered to correct deformities in the foot to remove excessive pressure in case all these measures does not work.
The primary goal of the treatment of arterial ulcers is to increase circulation to the area, either surgically or medically. Surgical options range from revascularization in order to restore normal blood flow to amputation and rehabilitation in extreme cases. Managing blood pressure, cholesterol, triglyceride and glucose levels can help in healing wound. Most ulcers heal after 3 or 4 months of treatment. However, some can take longer, and some may never clear up.

Prevention of Skin Ulcer:

There are a variety of ways you can prevent skin ulcers through lifestyle changes, diet or medication. These include:

  • Quit smoking as smoking can harden or clog the arteries, leading to improper perfusion to the extremities.
  • Lose weight
  • Avoid crossing legs while sitting.
  • Avoid cold temperature.
  • Protect legs and feet from injury and infection.
  • Manage blood pressure, cholesterol, triglyceride and glucose levels.
  • Ensure that footwear is properly fitted to avoid points of rubbing or pressure. Avoid wearing constrictive socks.
  • Take aspirin to prevent blood clots
  • Reduce the amount of salt in your diet
  • Exercise regularly
  • Wear compression stockings
  • Keep your legs elevated when you can
  • Examine feet, especially between the toes and legs daily for any unusual changes in color or the development of sores.
  • The following tips can help prevent future skin ulcers:
  • Keep awareness about your risks for skin ulcers such as any chronic condition.
  • Keep the skin clean and dry.
  • Reposition frequently.
  • Use protective devices such as pillows, foam wedges, and heel protectors for the knees, ankles, and heels.
  • Avoid immobilization.

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