Skin Ulcer
An open sore where skin and tissue break down and won't heal
Quick Facts
- Type: Skin and wound condition
- Common causes: Poor circulation, pressure, diabetes
- Common sites: Legs, feet, ankles, pressure points
- Seek care: Signs of infection, spreading redness, fever
Overview
A skin ulcer is an open sore that forms when the skin and the tissue beneath it break down and do not heal in the normal way. Unlike a simple cut or scrape that closes within days, an ulcer tends to linger, sometimes for weeks or months, because something is interfering with healing, most often poor blood supply, ongoing pressure, or nerve damage.
Skin ulcers are common on the lower legs, ankles, and feet, and over bony pressure points in people who are immobile. Because they are open wounds, they can become infected and, if the cause is not addressed, can slowly enlarge. Identifying and treating the underlying cause is just as important as caring for the wound itself.
Symptoms
A skin ulcer usually looks like a crater or open area where the surface skin is missing. Surrounding signs help indicate the cause and whether infection is present.
- An open sore with a red, pink, yellow, or dark wound bed
- Surrounding skin that may be discolored, swollen, hardened, or itchy
- Drainage, which can be clear, cloudy, or bloody
- Pain, although some ulcers (such as diabetic foot ulcers) may be painless due to nerve damage
- A foul smell or increasing drainage if infected
Signs of spreading infection include warmth, expanding redness, swelling, pus, fever, and worsening pain, and these need prompt medical attention.
Causes
Skin ulcers form when blood flow, pressure, sensation, or skin integrity is disrupted. The main types include:
- Venous ulcers: Caused by poor return of blood in the leg veins, usually near the ankles.
- Arterial ulcers: Caused by reduced arterial blood flow, often on the toes, feet, or pressure points, and frequently painful.
- Pressure ulcers: Caused by sustained pressure over bony areas in people who are bedbound or use a wheelchair.
- Diabetic (neuropathic) ulcers: Caused by nerve damage and poor circulation, typically on the soles of the feet.
- Infection or other causes: Some ulcers stem from infection, inflammation, or, rarely, skin cancer.
Risk Factors
- Diabetes, especially with nerve damage or poor foot care
- Poor circulation from peripheral artery disease or venous insufficiency
- Limited mobility or being bedbound
- Smoking, which impairs blood flow and healing
- Older age and previous ulcers
- Obesity and swelling of the legs
Diagnosis
Diagnosis focuses on identifying the type of ulcer and what is preventing it from healing:
- Examination: The location, appearance, and surrounding skin point toward the cause.
- Circulation tests: Checking pulses and blood pressure in the limb, sometimes with ultrasound, assesses arterial and venous flow.
- Blood tests: Used to check for diabetes, infection, and other contributing conditions.
- Wound swabs or biopsy: Taken if infection is suspected or if a non-healing ulcer needs to be evaluated for unusual causes.
Treatment
Successful treatment combines local wound care with correcting the underlying problem.
- Wound care: Cleaning the wound, removing dead tissue, and using appropriate dressings to keep the area moist and protected.
- Addressing circulation: Compression therapy helps venous ulcers, while procedures to improve blood flow may be needed for arterial ulcers.
- Relieving pressure: Repositioning, special mattresses, and offloading devices help pressure and diabetic foot ulcers heal.
- Treating infection: Antibiotics are used when infection is present.
- Controlling underlying disease: Managing diabetes, stopping smoking, and good nutrition all support healing.
Some ulcers heal in weeks, while others take months and need ongoing specialist wound care.
Prevention
- Manage diabetes and check the feet daily for sores
- Treat poor circulation and use compression stockings if advised
- Reposition regularly and use pressure-relieving cushions if mobility is limited
- Keep skin clean, moisturized, and protected from injury
- Stop smoking and maintain good nutrition
- Wear well-fitting footwear to prevent foot wounds
When to See a Doctor
See a doctor for any sore that does not begin to heal within a couple of weeks, that recurs, or that is linked to diabetes or poor circulation. Seek prompt care if an ulcer shows signs of infection, such as spreading redness, warmth, swelling, pus, foul odor, or fever. Get urgent care if you have severe pain, the skin around the wound turns dark or black, or you feel generally unwell, as these can signal a serious infection or loss of blood supply.
Frequently Asked Questions
Why won't my skin ulcer heal?
Ulcers fail to heal when something blocks the normal healing process, most often poor circulation, ongoing pressure, nerve damage, infection, or poorly controlled diabetes. Treating the underlying cause, not just the wound, is essential, which is why these sores need medical evaluation.
When is a skin ulcer an emergency?
Seek urgent care if the skin around the ulcer is rapidly spreading redness, becomes very painful, turns dark or black, or if you develop a fever or feel generally unwell. These can signal a serious infection or loss of blood supply that needs immediate treatment.
How are leg ulcers treated?
Treatment combines wound care with correcting the cause. Venous ulcers usually improve with compression therapy, arterial ulcers may need procedures to restore blood flow, and all benefit from cleaning, appropriate dressings, and managing conditions like diabetes.
Can skin ulcers be prevented?
Many can. Checking the feet daily if you have diabetes, treating poor circulation, repositioning if you have limited mobility, wearing good footwear, and not smoking all lower the risk. Early attention to any small wound prevents it from becoming a chronic ulcer.
References
- MedlinePlus, U.S. National Library of Medicine. Leg and foot ulcers.
- Mayo Clinic. Bedsores (pressure ulcers).
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetic foot problems.
- Centers for Disease Control and Prevention (CDC). Diabetes and your feet.