Pressure ulcers

When to get medical advice

Phone 111 or contact your GP practice urgently if:

You or someone you care for has symptoms of a pressure ulcer and:

• hot, swollen or red skin – it can look purple or blue on brown or black skin
• pus coming out of the ulcer
• a high temperature
• severe pain or pain that’s getting worse

Contact your GP practice if:

• you think you or someone you care for has a pressure ulcer

Who’s most at risk of pressure ulcers?

Pressure ulcers can happen to anyone, but it’s more common if you have problems moving. This is because the weight of your body puts pressure on the same areas of skin which can damage it.

You have a higher chance of getting a pressure ulcer if you have:

• problems moving
• had a pressure ulcer before
• been seriously ill in intensive care
• recently had surgery
• swollen, sweaty or broken skin
• poor circulation
• fragile skin
• problems feeling sensation or pain

It’s also more likely if you’re underweight.

Severity of pressure ulcers

Pressure ulcers can vary in severity.

Healthcare professionals in Scotland use a grading system to describe how severe pressure ulcers are. In other places, a category or staging system may be used.

The higher the grade or category, the more severe the pressure ulcer is.

A grade 1 pressure ulcer is the least severe type of ulcer.

A grade 1 pressure ulcer may:

• be painful
• feel warm or cool
• feel either warm and spongy, or hard
• cause the affected area of skin to become discoloured

It may not:

• turn white when pressed
• have an open wound

This stage of pressure ulcer might be difficult to detect in darker skin tones.

In grade 2 pressure ulcers, some of the outer surface of the skin (epidermis) or the deeper layer of skin (dermis) is damaged. This can lead to skin loss.

The ulcer looks like an open or burst blister. This can be red or pink. It won’t have any yellow or white in the wound.

In a grade 3 pressure ulcer, skin loss can affect the entire thickness of the skin. The tissue underneath is also damaged, but the bone, muscle or tendon are not.

The ulcer looks like a deep wound and there might be signs of of dead tissue. For example, there may be white, yellow or green discharge coming from the wound.

A grade 4 pressure ulcer is the most severe type of pressure ulcer.

The skin is severely damaged and the tissue around it begins to die. This is called tissue necrosis. The bone, muscles or tendons underneath may be damaged.

People with grade 4 pressure ulcers have a high risk of developing an infection.

Suspected deep tissue injury (SDTI)

A SDTI occurs when the top layer of the skin isn’t broken, but it’s thought there’s a problem underneath the skin.

A SDTI may mean:

• the surface of the skin isn’t broken
• the skin is purple or brownish red
• there’s a blister filled with blood
• the skin breaks down and causes deep tissue loss
• the depth of the wound isn’t known

Ungradable/unstageable

An ungradable or unstageable pressure ulcer means the area is covered by dead body tissue. Healthcare professionals won’t be able to tell how deep the wound is. They may be able to find out what grade or category the pressure ulcer is after dead tissue has been removed.

Mucosal pressure ulcer

Mucosal pressure ulcers affect soft and delicate areas of the body (mucosal membranes) like:

• tongue
• nostrils
• mouth

Mucosal membranes can’t be graded because they don’t have layers of skin like the rest of the body. This means they’re called mucosal pressure ulcers.