Pressure ulcer stages 1 to 4 with photos

Stage 1 pressure sore

The ^first stage of pressure ulcers is erythema, also called stage 1 pressure ulcers . Erythema is defined as redness of the skin that does not fade under pressure from a finger. This erythema is red , hot and generally painful. It corresponds to an attack on the epidermis or even the dermis (upper part of the skin). In people with fair skin, according to the definition of pressure ulcers , it appears as persistent redness, while in people with darker skin, the pressure ulcer may be red, blue or even purplish. In stage 1, a pressure ulcer is a minor wound that affects the upper layer of the skin (epidermis). It may be red and swollen, but does not show signs of infection. The skin around the pressure ulcer may be red and hot to the touch, but the wound itself is not painful.

Photo of a stage 1 pressure ulcer

Treating a stage 1 pressure ulcer

This first stage of the pressure ulcer is the most benign (less serious) but nevertheless requires care and special attention. This stage is quickly reversible with appropriate care (such as regular changes in position, the use of specialized equipment such as anti-pressure ulcer mattresses or the use of a liquid healing dressing , etc.), hence the need to be vigilant and regularly observe the potential pressure areas of patients at risk. If the erythema is not detected early enough, if it is poorly managed, or if the care is not sufficient, it can then progress to a more serious stage: stage 2 of the pressure ulcer.

Stage 2 pressure sore

Stage 2 of the pressure ulcer corresponds to the stage of de-epidermization or that of the phlyctene . It is simply the formation of a superficial wound caused by the loss of part of the epidermis and/or the dermis. This stage can also appear in the form of a phlyctene (blister) filled with transparent liquid or blood (which can often make one think of the more serious stage of the pressure ulcer which is necrosis). The phlyctene corresponds to a detachment of the epidermis filled with a pocket of liquid or blood. Just like stage 1, this stage can be painful and can quickly progress to more serious stages such as stages 3 and 4 of the pressure ulcer if it is not treated correctly and especially quickly. At this stage, it is important to promote the healing of the wound .

Photo of a stage 2 pressure ulcer

Treating a stage 2 pressure ulcer

To treat a stage 2 pressure ulcer, it is recommended to follow these steps:

1. Clean and disinfect the wound : It is important to clean and disinfect the wound to prevent the onset of infection. This can be done by using antiseptic solutions or by performing surgical cleaning of the wound.
2. Removal of dead tissue: If the wound is deep and contains dead tissue, it may be surgically removed to allow the wound to heal.
3. Wound protection : It may be necessary to protect the wound with a dressing or special cushion to avoid additional pressure on the affected area.
4. Treating the underlying cause : It may be necessary to treat the underlying cause of the pressure ulcer, such as a problem with blood circulation or reduced mobility.
5. Drug treatment: Medications may be used to relieve pain.
6. You can use Antiscar to effectively promote wound healing (liquid dressing gel based on glycerol, honey and polymers)

Stage 3 pressure sore

Stage 3 is the stage of necrosis , that is, the death of living tissues and skin cells. This stage is characterized by the formation of a deep wound in the skin (unlike stage 2 which is characterized by a superficial wound or blister) this time affecting the epidermis, dermis and subcutaneous tissues but without reaching the underlying muscles and bones. The skin becomes necrotic, it becomes black and very rigid. This is a serious stage of pressure ulcer. In stage 3, a pressure ulcer is a serious wound that reaches the deep layers of the skin and underlying tissues. It can be very painful and may be accompanied by infection. The skin around the pressure ulcer may be red, swollen and hot to the touch, and the wound itself may be deep and oozing. It is important to treat a stage 3 pressure ulcer quickly to avoid complications and promote healing. Treatment may include surgery to remove dead tissue and protect the wound, as well as medications to relieve pain and treat any infection that may be present.

Photo of stage 3 bedsore

Stage 4 pressure sore

Finally, the most serious stage is stage 4 , this is ulceration. This ulceration appears after the necrosis stage. This is a deep or even very deep wound . The eschar is characterized by a loss of the entire thickness of the skin with significant destruction of tissues, this time extending to the muscles and bones. There may also be damage to the tendons or joints. The bones and muscles are exposed and visible.

Photo of stage 4 pressure ulcer (sacral pressure ulcer)

Complications of pressure ulcers

Many complications can follow this stage of ulceration. These complications include:

• Osteomyelitis (inflammation and destruction of bones caused by bacteria or fungi)
• Cellulitis (inflammation of the skin and subcutaneous tissues caused by bacteria)
• Bacteremia (presence of bacteria in the blood)
• Meningitis (inflammation of the meninges located in the brain)
• Endocarditis (infection caused by bacteria affecting the inner walls of the heart)

The more advanced the stage of the pressure ulcer, the lower the chances of recovery and the longer and more difficult the healing period. It is therefore very important to diagnose this type of injury early. The physical and psychological consequences for patients can be significant, which is why prevention is essential. The use of liquid dressings such as Antiscar is a solution to prevent the appearance of stage 4 pressure ulcers.

Diagram: Mechanism of pressure ulcers