What Is a Skin Ulcer?

Overview

An untreated skin ulcer can lead to serious problems.
An untreated skin ulcer can lead to serious problems.

Skin ulcers are open sores on your skin that don’t heal the way they should. You might get one from an injury, bad blood circulation, or continuous pressure on the area. You’re most likely to get them on your feet and legs. They can, though, also form in other areas like on your hands or in folds of skin on your body.

Ulcers can start out small and grow larger. But you may not notice one until it’s larger than a quarter or even a silver dollar. Here is information that can help you learn how to recognize skin ulcers and know what you should do if you have one.

How Will I Know It’s an Ulcer?

If you’ve got an open sore that doesn’t get better as fast as it should, it could be an ulcer. If you do have an ulcer, it might look:

  • Inflamed
  • Swollen or crusty or both
  • Red, pink, yellow, brown, gray, or black

You might also notice:

  • A strong odor
  • Green or yellow discharge
  • Pain (but not always)

What Kind of Ulcer Could I Have?

There are three common types of skin ulcers:

  • Arterial (also known as ischemic) ulcers: These usually affect people with poor blood flow in their legs. They tend to crop up on feet, especially heels, toes, and near the nail bed.
  • Neurotrophic (also known as diabetic) ulcers: If you have nerve damage that makes it hard to feel your feet, you could develop neurotrophic ulcers. These are often a problem for people whose nerve damage is from diabetes. The ulcers appear most often on feet, especially on pressure points on the soles of the feet or areas where shoes press on the skin.
  • Venous stasis ulcers: Venous stasis ulcers are common in people with leg swelling, spider (or varicose) veins, or a history of blood clots in their legs. They’re always on the leg, usually between the knee and ankle.

Your doctor will figure out which type of ulcer you have based on how it looks and where it is.

What Causes Ulcers?

Ulcers form when you injure the outer layers of your skin. That leaves deeper layers exposed and unprotected. For most people, the injured outer skin layers heal and don’t cause a problem.

Ulcers usually arise when your skin doesn’t heal because of another problem such as:

Smoking can also raise your risk for ulcers. That’s because it damages nerves and blood vessels. Other less taboo behaviors can raise risk for ulcers, too. You might be at greater risk if you:

  • Wear tight clothing or ill-fitting shoes
  • Don’t move regularly
  • Don’t get treatment for wounds or infections right away

Your risk for ulcers may be in your genes, too. If your parents or close relatives were prone to them, you may be too.

How Do You Treat an Ulcer?

An untreated ulcer can lead to serious problems -- including the need for amputation. If you think you have an ulcer, see your doctor right away. The sooner you get treatment, the less likely you are to have another problem.

Your doctor will examine your skin and may take an X-ray to see if your ulcer has affected the nearest bone. In some cases, your doctor may use other tests to see if you have blood vessel disease.

Next, your doctor will treat your ulcer with a procedure called debridement. Here, the doctor removes unhealthy tissue from the wound to start the healing process. Your doctor may prescribe medications, such as antibiotics, that you swallow or rub on the sore.

Talk to your doctor about how to care for your ulcer at home. You might need to:

  • Clean your ulcer daily with soap and water. Don’t use hydrogen peroxide or soak your wound in a bath or whirlpool. This can discourage healing and increase your risk of infection.
  • Keep your ulcer bandaged or covered with a wound dressing. Your doctor may recommend specific bandaging steps. “Airing out” a wound increases your odds of infection and slows healing.
  • Apply medications such as saline, skin substitutes, and substances that make skin cells grow.
  • Take better care of other health problems, such as diabetes or vascular disease.
  • Keep pressure off your ulcer, especially if it’s on your foot.

You might need crutches, special footwear, a brace, or other devices to reduce pressure and irritation so your ulcer heals faster.

If your ulcer doesn’t heal in about a month or becomes infected and spreads to your bones, you may need surgery or hyperbaric oxygen therapy. That’s when you breathe pure oxygen in a special room in order to help your body heal. Ulcers that don’t heal can develop gangrene. That’s when tissue dies because the area didn’t get enough blood flow. If this happens, your doctor may have to remove the affected body part such as your foot or leg.

How Can You Prevent Ulcers?

There’s a lot you can do to reduce your risk for ulcers:

  • Check yourself: If you can’t feel parts of your body -- such as your feet -- because of nerve damage, take a look at them every day. Look for blisters, cuts, cracks, sores, redness, white spots, thick calluses, discoloration, or other changes. If you feel warmer or colder than usual, that can be a sign that you have an open wound. But you may not feel anything. If you can’t check your legs or feet yourself, ask a family member to help.
  • Protect your feet: Don’t walk barefoot, especially if you have diabetes or can’t feel your feet. A foot injury can increase your risk for ulcers. Shoes that cover the whole foot, instead of sandals or flip-flops, are best.
  • Quit smoking: Cigarettes damage blood vessels, decrease blood flow, and slow healing. Those things increase your risk for ulcers and amputation. If you smoke, talk to your doctor about resources that can help you kick the habit.
References
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Cleveland Clinic: “Leg and Foot Ulcers,” “Diabetic Ulcers: Why You Should Never Ignore Them.” American College of Foot and Ankle Surgeons, Foot Health Facts: “Ulcers.” American Academy of Dermatology: “Diabetes.” Joel Schlessinger MD, dermatologist, past president of the Nebraska Dermatology Society, President Emeritus of the American Society of Cosmetic Dermatology and Aesthetic Surgery, Omaha, Nebraska. Mayo Clinic: “Gangrene.” American Podiatric Medical Association: “Diabetic Wound Care.” National Health Service (UK): “Amputation.” American Orthopaedic Foot & Ankle Society: "Diabetic Foot Problems." American Diabetes Association: “Foot Complications.”
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