FFinalistSouthampton · 2027
Dermatology
AKT · Dermatology/Wounds, ulcers & burnslow yield

Pressure sore (pressure ulcer)

Localised skin/tissue damage from sustained pressure/shear

Overview

Localised damage to skin and underlying tissue from sustained pressure (and shear) over a bony prominence — sacrum, heels, ischial tuberosities, greater trochanter. Largely PREVENTABLE; managed by relieving pressure, optimising the patient, and graded by depth (Category/Grade 1–4).

Recognise

  • Over bony prominences in immobile patients (sacrum, heels, hips); risk rises with immobility, poor nutrition, incontinence, reduced sensation and poor perfusion
  • Graded: 1 = non-blanching erythema (intact skin); 2 = partial-thickness (abrasion/blister); 3 = full-thickness to subcutaneous fat; 4 = down to muscle/bone/tendon
  • Risk assessed by tools (Waterlow/Braden); the SSKIN bundle structures prevention

Red flags

  • Category 3–4 ulcer, undermining/sinus, spreading infection, or suspected osteomyelitis → tissue viability/specialist input

Differentials & how to tell them apart

Moisture-associated dermatitis (incontinence)diffuse erythema in the perineum from moisture, not over a bony point with pressure damage
Diabetic/neuropathic ulcerplantar pressure point with neuropathy
Arterial ulcerischaemic, painful, distal

Clinical image

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Pressure sore (pressure ulcer) — clinical imagesDermNet

Investigations

Risk assessment (Waterlow/Braden) and skin inspection; grade the ulcer; assess for infection/osteomyelitis; nutritional assessment.

Management

Relieve pressure (repositioning + support surfaces) + grade-appropriate wound care + nutrition

  1. 1Relieve and redistribute pressure (regular repositioning, pressure-redistributing mattress/cushion, heel protection), grade-appropriate wound care, optimise nutrition and manage incontinence — the SSKIN bundle.Gate: Prevention IS the treatment — pressure redistribution and repositioning are the foundation; antibiotics are only for clinical INFECTION, not for a colonised or malodorous wound
  2. 2Category 3–4 / non-healing → tissue viability team, debridement, possible reconstructive surgery; treat infection/osteomyelitis; ongoing risk assessment.
Pressure redistribution (repositioning + support surfaces) — the core treatment and prevention
Wound care/debridement appropriate to grade — dressings; debride slough/necrosis
Nutritional optimisation — protein/calorie support aids healing
Antibiotics only if clinically infected — not for colonisation

Key points

Grade by depth and prevent with SSKIN (Surface, Skin inspection, Keep moving, Incontinence, Nutrition). Category 1 is non-blanching erythema on INTACT skin — the earliest warning to act.

Monitor & prognosis

Grade/healing, risk reassessment, infection, nutrition.

Higher grades heal slowly; prevention is far more effective than treatment.

Source: NICE CG179 (pressure ulcers); NICE CKS