What is the first sign of skin breakdown

Índice Show

What causes minor skin breakdown?
What are the signs of minor skin breakdown?
How should I care for my child’s minor skin breakdown?
When should I call the clinic?
What else do I need to know?

Skin breakdown can range from minor scrapes, cuts, tears, blisters or burns. Minor skin breakdown is tissue damage caused by friction, shear, moisture or pressure and is limited to the top layer of skin.

What causes minor skin breakdown?

In the hospital setting, there are several ways that skin breakdown can occur.

Cleaning the skin before applying a medical device such as EEG leads
Pressure from a medical device for example from an IV or a feeding tube

What are the signs of minor skin breakdown?

Unopened skin that has redness, bruising or blisters
Open skin that is red in color

How should I care for my child’s minor skin breakdown?

Wash your hands well with soap and water or hand sanitizer
Wash the skin with mild soap and warm water
Apply a thin layer of petroleum jelly to the open skin and cover with a bandage

When should I call the clinic?

Call the clinic if:

Temperature higher than 101 F
The area near the minor skin breakdown becomes bright red, swollen or painful
There is odor coming from the open skin
The drainage from the open skin becomes yellow or green in color

What else do I need to know?

If the skin is not open, we may recommend covering with a bandage for protection
Minor skin breakdown heals best when kept moist using petroleum jelly. Antibiotic ointments slow healing and are often not needed. Do not “air out” minor skin breakdown. Allowing air to the open skin will increase the time to healing.

This information is not specific to your child but provides general information. If you have any questions, please call Children’s Wound Care Team at 651-220-6530.

Reviewed 3/2019

This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Minnesota Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

Medically Reviewed by Carol DerSarkissian, MD on November 11, 2020

Stage 1
Stage 2
Stage 3
Stage 4
Other Stages

You may know pressure sores by their more common name: bed sores. They happen when you lie or sit in one position too long and the weight of your body against the surface of the bed or chair cuts off blood supply. You might get them if you’re on bed rest or in a wheelchair.

Your doctor may talk about the “stage” of your pressure sores. The stages are based on how deep the sores are, which can affect their treatment.

If found early, there's a good chance these sores will heal in a few days, with little fuss or pain. Without treatment, they can get worse.

You'll know they’re better when the sore gets smaller and pink tissue shows up along the sides.

This is the mildest stage. These pressure sores only affect the upper layer of your skin.

Symptoms: Pain, burning, or itching are common symptoms. The spot may also feel different from the surrounding skin: firmer or softer, warmer or cooler.

You may notice a red area on your skin. If you have darker skin, the discolored area may be harder to see. The spot doesn’t get lighter when you press on it, or even 10 to 30 minutes after you stop pressing. This means less blood is getting to the area.

What to do: The first and most important thing to do with any pressure sore is to stop the pressure. Change your position or use foam pads, pillows, or mattresses.

If you spend a lot of time in bed, try to move at least once every 2 hours. If you’re sitting, move every 15 minutes. You may need someone to help you.

Wash the sore with mild soap and water and dry it gently.

It may help to eat a diet high in protein, vitamins A and C, and the minerals iron and zinc. These are all good for your skin. Also, drink plenty of water.

Recovery time: A Stage 1 pressure sore may go away in as little as 2 or 3 days. If it hasn't, call your doctor.

This happens when the sore digs deeper below the surface of your skin.

Symptoms: Your skin is broken, leaves an open wound, or looks like a pus-filled blister.

The area is swollen, warm, and/or red. The sore may ooze clear fluid or pus. And it’s painful.

What to do: Follow the same steps for Stage 1. You should also clean the wound with water or a salt-water solution and dry it gently. This may hurt, so ask your doctor if you should take a pain reliever 30 to 60 minutes before cleaning.

Keep the sore covered with a see-through dressing or moist gauze. If you see signs of an infection (such as pus, fever, or redness), tell your doctor.

Recovery time: A Stage 2 pressure sore should get better in 3 days to 3 weeks.

These sores have gone through the second layer of skin into the fat tissue.

Symptoms: The sore looks like a crater and may have a bad odor. It may show signs of infection: red edges, pus, odor, heat, and/or drainage. The tissue in or around the sore is black if it has died.

What to do: Stage 3 sores will need more care. Talk to your doctor. They may remove any dead tissue and prescribe antibiotics to fight infection. You may also be able to get a special bed or mattress through your insurance.

Recovery time: A Stage 3 pressure sore will take at least one month, and up to 4 months, to heal.

These sores are the most serious. Some may even affect your muscles and ligaments.

Symptoms: The sore is deep and big. Skin has turned black and shows signs of infection -- red edges, pus, odor, heat, and/or drainage. You may be able to see tendons, muscles, and bone.

What to do: Tell your doctor right away. These wounds need immediate attention, and you may need surgery.

Recovery time: A Stage 4 pressure sore could take anywhere from 3 months or much longer, even years, to heal.

In addition to the 4 main stages for bed sores, there are 2 others:

"Unstageable" is when you can’t see the bottom of the sore, so you don’t know how deep it is. Your doctor can only stage it once it’s cleaned out.

"Suspected Deep Tissue Injury" (SDTI). This is when the surface of the skin looks like a Stage 1 or 2 sore, but underneath the surface it’s a Stage 3 or 4.

Skin sores can develop due to pressure, friction, moisture, burns or even accidents. They often happen without a person knowing it because of absent sensation to the area. Sores can easily become infected and may channel into deeper levels of muscle and bone. Healing can be difficult and may lead to future problems that require surgery and long hospital stays. Please read on for more information on the different causes and signs of skin problems.

Causes of Skin Problems

Pressure is the biggest cause of skin breakdown and sores because it decreases blood flow to the skin. It is most likely to occur over bony areas where there is not much padding between the skin and the bones.

Examples of pressure include:

Sitting or lying in one position for long periods
Wearing clothes or shoes that are too tight
Using a wheelchair that is the wrong size
Wearing casts or splints that are too tight
Not using a properly adjusted wheelchair cushion
Sitting on unpadded surfaces

Pressure problems can be prevented by:

Doing weight shifts correctly and on time
Wearing properly fitting clothes and shoes
Using properly fitted wheelchair and cushion
Inspecting wheelchair regularly for wear and tear
Checking skin under splints regularly and removing them if red spots are noticed
Calling the doctor promptly when skin breaks down

Shearing happens when something stretches or pulls on the skin. This also leads to decreased blood flow to the skin and deeper tissues under the skin.

Shearing can occur as a result of:

Slumping in the wheelchair
Sliding the body over a surface such as when doing a transfer or raising up in bed
Sitting in bed too long

Friction is another way the skin can be injured. It occurs when the skin is rubbed hard across another surface. Friction can actually result in an open area on the skin.

Examples of friction include:

Any movement that causes a body part to rub across another surface
Performing a sliding board transfer incorrectly and rubbing the buttocks over the wheelchair tire

Accidents can also happen. They include bumps, bruises, cuts or burns th

at injure the skin. Remember that feeling may be decreased or absent so a person may not even know that an injury occurred during an accident.

Examples of accidents include:

Bumping feet in doorways when moving about in a wheelchair
Coming in contact with things that are hot (surfaces, boiling water, reaching over a hot burner)
Bumping any body part
Spilling hot drinks

Accidents can be prevented. Consider the following:

Be careful when driving your chair so as not to bump any body parts.
Use a lapboard attached to your chair when cooking or carrying hot things.
Cook on the front burners so you do not have to reach over hot surfaces (if possible).
Use a cup holder attached to your wheelchair for hot liquids.

Moisture is wetness on the skin. It can soften the skin too much and make it more likely to break down and become a sore.

Examples of moisture include:

Urine that stays on the skin from wetting accidents, leaking condom catheter or poor hygiene
Stool that stays on the skin from bowel accidents or poor hygiene
Sweat from overheating or infections with fever
Water

Moisture problems can be avoided. Try the following to prevent skin breakdown from moisture:

Perform bladder program on time and empty completely each time. Avoid bladder accidents.
(Men) wear a condom catheter in case of reflex in between bladder programs.
Perform bowel program on time, each time and for the proper amount of time.
Avoid bowel accidents.
Clean the skin right away if bowel or bladder accidents happen.
Dry off sweat that results from activity or fever.
Change bathing suit after swimming to avoid sitting in wetness for long periods.
Use petroleum jelly on buttocks area if diarrhea is a problem.
Stay dry!

Swelling of the limbs (usually the feet or hands) can result from absent or limited movement. Extra body fluids collect in the limbs and make the skin very fragile

Ways to decrease swelling include:

Avoid pressure on legs and hands.
Elevate legs and hands several times a day (prop on pillows/foam pads while in bed).
Wear support stockings (TED hose or JOBST stockings).
Keep shoes loose.

Other problems of the skin can be caused by poor nutrition, smoking, dry and flaky skin, poor hygiene when cleaning after bowel or bladder programs and worn out wheelchair cushions.

Signs of skin problems include:

reddened or darkened areas
swelling
any change in the color of the skin
raised or hardened areas
bruises
warm areas felt near a red, dark, raised or hardened area
blisters
rashes
any opening on the skin

Skin is more likely to exhibit problems over bony areas. Pressure points will vary depending on whether the person is sitting or lying on the back, side or stomach. Please review the following pictures of positions and potential skin breakdown areas.

Pressure areas likely to happen while on the back:

Pressure areas likely to happen while sitting:

Pressure areas likely to happen while on the side:

Pressure areas likely to happen while on the stomach:

It is important to check the skin at least twice a day. Skin checks are quick and easy to do and will save the skin from unwanted skin sores. Prevention is the key!