What Is the Pressure Ulcer? A Doctor-Reviewed Answer

A pressure ulcer is an area of skin and underlying tissue damaged by prolonged pressure, usually over a bony part of the body. Brief pressure-related redness is common and often settles after position changes, but skin that stays discolored, painful, blistered, or open needs prompt medical assessment.

What is a pressure ulcer?

A pressure ulcer, also called a pressure injury, pressure sore, or bedsore, is damage to the skin and sometimes the tissue beneath it caused by sustained pressure. It most often develops when someone remains in one position for a long time, such as while lying in bed or sitting in a chair or wheelchair. The pressure can reduce the blood supply needed to keep tissues healthy.

Short-lived redness after leaning or lying in one position is common and often improves when pressure is relieved. A pressure ulcer is more concerning because the skin does not recover normally, or because there is a blister, wound, or deeper tissue damage. Prompt attention to early changes can often prevent progression and support healing.

Pressure ulcers can occur in any care setting, including at home, in hospital, in rehabilitation, or in long-term care. They are not a sign that a person or caregiver has failed; they can arise despite careful care when illness, frailty, reduced movement, or circulation problems make skin more vulnerable.

Where pressure ulcers develop and what they look like

Pressure ulcers usually form over bony areas where there is little natural cushioning. Common locations include the tailbone, buttocks, hips, heels, ankles, elbows, shoulder blades, back of the head, knees, and ears. The exact location depends on whether a person spends most of their time on their back, side, stomach, or sitting upright.

Early skin changes may look different across skin tones. On lighter skin, an early area may appear red and may not turn pale when gently pressed. On darker skin, it may look darker than the surrounding skin, purple, bluish, ashen, or unusually shiny. It may also feel warmer or cooler, firmer or softer, painful, itchy, or tender compared with nearby skin.

As damage advances, the area may develop a blister, a shallow open wound, or a deeper crater. Some severe injuries are covered by yellow, brown, or black tissue, which can make their true depth difficult to judge. Not every skin wound is a pressure ulcer, so an assessment by a healthcare professional is important when the cause is uncertain.

Why pressure ulcers happen and who is at risk

Prolonged pressure is the main cause, but friction and shear also contribute. Friction occurs when skin rubs against bedding, clothing, or a surface. Shear occurs when the skin stays in place while deeper tissues move, for example when a person slides down in bed with the head raised. These forces can injure tissue even before an open wound appears.

People at greater risk include those who cannot change position independently because of illness, surgery, injury, stroke, weakness, paralysis, sedation, or advanced age. Reduced sensation can also prevent a person from noticing discomfort and shifting their weight. Conditions affecting blood flow, such as diabetes or peripheral artery disease, may further slow skin repair.

Other contributors include incontinence, sweating, wound drainage, dehydration, poor food intake, unintentional weight loss, swelling, fever, and fragile skin. Medical devices can create localized pressure as well; oxygen tubing, masks, casts, braces, and catheters should be checked regularly for skin irritation or pressure marks.

• Limited mobility or inability to reposition without help
• Reduced feeling of pain or pressure
• Moisture from urine, stool, sweat, or drainage
• Poor nutrition, dehydration, or recent weight loss
• Diabetes, poor circulation, or serious acute illness

How doctors assess and stage a pressure ulcer

A doctor or wound-care clinician will usually examine the skin, ask when the change was first noticed, and review mobility, nutrition, continence, medications, medical conditions, and the surfaces used for sitting or lying down. They may assess circulation, sensation, pain, temperature, and signs of infection. In people at risk, clinicians also use structured risk assessments to guide prevention planning.

Pressure injuries are commonly described by stages. Stage 1 involves intact skin with persistent discoloration. Stage 2 is partial-thickness skin loss, such as a shallow open area or blister. Stage 3 involves full-thickness skin loss and may show fat tissue. Stage 4 extends into deeper structures such as muscle, tendon, or bone. Some wounds are called unstageable when the base is covered by dead tissue, while deep tissue pressure injuries may appear as persistent deep red, maroon, or purple discoloration before the skin opens.

Testing is not always necessary. However, a clinician may take a wound sample if infection is suspected, request blood tests when nutritional or systemic concerns are present, or use imaging if there is concern that a deep ulcer has affected bone or deeper tissue. The diagnosis also includes distinguishing pressure injury from moisture-associated skin damage, venous ulcers, arterial ulcers, diabetic foot ulcers, or other skin conditions.

Treatment and healing support

Treatment begins by removing or reducing pressure from the affected area. This may involve an individualized repositioning schedule, assistance with transfers, pressure-redistributing mattresses or cushions, and avoiding direct pressure on the wound. The best plan depends on the person’s mobility, the wound location, overall health, and comfort.

Wound care may include gentle cleansing and a suitable dressing to protect the area and manage moisture. A clinician selects dressings based on the wound’s depth, drainage, surrounding skin, and presence of dead tissue. Some wounds need debridement, a procedure that removes nonviable tissue to support healing. Surgery is occasionally considered for selected deep or non-healing ulcers after careful assessment.

Good nutrition and hydration are important because the body needs energy, protein, vitamins, and minerals to repair tissue. A doctor or dietitian may review food intake, swallowing issues, weight changes, and medical conditions that affect nutrition. Antibiotics are not routinely needed for every pressure ulcer, but they may be prescribed when there is a confirmed spreading skin infection, bone infection, or systemic infection.

Healing time varies widely. Superficial injuries may improve with early pressure relief and skin protection, while deeper ulcers can take much longer and need coordinated wound, medical, rehabilitation, and nutritional care. Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals can assess and treat pressure ulcers for international patients when specialist care is needed.

Prevention and daily skin care

Many pressure ulcers can be prevented or detected early through regular skin checks and pressure relief. A person who can move independently should be encouraged to change position often and avoid remaining in one posture for prolonged periods. People who need assistance may require a personalized repositioning plan from their healthcare team rather than a fixed schedule that does not account for comfort, mobility, and skin condition.

Skin should be kept clean and protected from excess moisture. After episodes of incontinence, gentle cleansing and a barrier product recommended by a clinician can help protect vulnerable skin. Bedding should be smooth and dry, and caregivers should use safe moving techniques or transfer aids rather than dragging a person across sheets, which can cause friction and shear.

Supportive cushions and mattresses can redistribute pressure, but they do not replace regular position changes and skin inspection. Checking heels, the tailbone, hips, and areas under medical devices is especially useful. Eating regular, balanced meals, drinking enough fluids when medically appropriate, and reporting reduced appetite or weight loss can also support skin health.

• Inspect skin daily, particularly over bony areas and beneath devices.
• Relieve pressure and change position as advised by a healthcare professional.
• Use cushions or mattresses designed to redistribute pressure when indicated.
• Manage moisture promptly and avoid rubbing fragile skin.
• Seek nutrition advice if food intake is poor or weight is falling.

When to seek medical care

Medical advice should be sought promptly if an area of skin remains red, dark, purple, or discolored after pressure has been relieved, especially if it is painful, warm, firm, swollen, or blistered. A new open area of skin should also be assessed, particularly in someone with diabetes, poor circulation, limited mobility, or reduced sensation.

Urgent medical assessment is appropriate for spreading redness, rapidly increasing swelling, pus or foul-smelling drainage, fever, chills, confusion, severe or worsening pain, or black tissue around a wound. These signs can indicate infection or more serious tissue damage and should not be managed with home remedies alone.

Until a clinician reviews the area, pressure should be kept off the affected site as much as possible. It is best not to massage discolored skin, pop blisters, apply harsh antiseptics, or remove dead tissue at home. Early professional guidance can clarify the cause of the skin change and provide a practical care plan for the person and caregivers.

Frequently asked questions

Is a pressure ulcer the same as a bedsore?

Yes. Pressure ulcer, pressure injury, pressure sore, and bedsore are terms commonly used for tissue damage caused by sustained pressure. Healthcare professionals increasingly use the term pressure injury because damage can begin below intact skin before an open sore is visible.

Can a pressure ulcer heal on its own?

Very early pressure-related skin changes may improve when pressure is relieved promptly and the skin is protected. However, an ulcer or persistent area of discoloration should be assessed by a healthcare professional, especially in a person with reduced mobility, diabetes, or circulation problems. Deeper wounds generally need a structured treatment plan.

How quickly can a pressure ulcer develop?

The timing varies according to the amount of pressure, a person's health, mobility, circulation, moisture exposure, and nutritional status. In vulnerable people, tissue damage can develop faster than expected. This is why regular repositioning and skin checks are important.

Should a pressure ulcer be covered or left open to air?

Most pressure ulcers benefit from an appropriate dressing rather than being left open to air. Dressings can protect the wound, maintain a suitable healing environment, and manage drainage. The right choice should be made by a clinician because different wounds require different care.

Can pressure ulcers become infected?

Yes, an open pressure ulcer can become infected, although not every wound is infected. Increasing redness, warmth, swelling, pain, drainage, odor, fever, or feeling unwell should be assessed promptly. A clinician can determine whether infection is present and whether antibiotics or other treatment are needed.

What is the best sleeping position to prevent pressure ulcers?

There is no single best position for everyone because risk areas and comfort differ. The key is to avoid prolonged pressure on the same area and follow an individualized repositioning plan. A nurse, doctor, physiotherapist, or occupational therapist can advise on safe positioning, pillows, heel protection, and suitable support surfaces.

References

• National Pressure Injury Advisory Panel
• National Health Service
• Mayo Clinic
• World Health Organization

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.