We all receive superficial wounds, scrapes or scratches that may break the skin and cause us to bleed, even a little bit. With basic first aid, these wounds generally heal on their own. Sometimes though, a wound has trouble healing. Open wounds that do not heal are known as skin ulcers or sores.
A skin ulcer appears as an area of skin that has broken down, revealing the underlying tissue. A skin ulcer may also ooze pus or fluid, may bleed, may become infected and may cause an unpleasant smell.
What Causes It?
There are many reasons why a skin ulcer might not be healing. The most common of these causes are listed below.
More than 17 million Americans suffer from diabetes, a chronic (long-term) condition caused by high levels of glucose (sugar) in the blood. About 15% of these patients will form a diabetic ulcer (neurogenic ulcer). This type usually forms on the foot as a result of nerve damage or poor circulation. Not cleaning feet often enough or wearing shoes that don’t fit well may hasten the development of diabetic ulcers.
Circulatory System Ulcers
Stasis dermatitis is a lifelong condition that puts people at risk for skin ulcers. Inside the veins in your legs are one-way valves that keep blood flowing toward your heart. When these valves weaken, blood flows back toward the feet and pool in your legs (venous insufficiency). Eventually, the surrounding skin breaks down and an ulcer appears, typically on the inside of your ankle.
Varicose veins (Varicosis), commonly called spider veins, occur when your veins become overfilled with blood, most often affecting the legs. They can be painful, appearing raised with blue, purple or red coloring. Half of all Americans over the age of 50 suffer from varicose veins. The effects of this condition include swelling, discoloration and sometimes ulcers form around the ankles.
Arterial ulcers are a common, often painful type of skin ulcer caused by atherosclerosis (peripheral arterial disease). This disease causes plaque to build up in your arteries, significantly limiting the flow of oxygen-rich blood to your body. When plaque builds up in the narrow arteries of the foot, arterial ulcers can form, usually on toes or heels.
Pressure ulcers (bedsores) are skin ulcers caused by pressure sores can form quickly as a result of staying in one position for too long. This can happen from being bedridden due to illness or loss of mobility, or from using a wheelchair. Pressure sores form when an area of skin dies due to prolonged pressure. They typically form on the ankle, back, elbow, hip or heel.
Parasitic ulcers (leishmaniasis), is a complicated sounding name but is simply caused by the bite of a sand fly that carries a parasitic disease. About 350 million people worldwide are at risk for leishmaniasis. Some people will not feel any effects at all, but for others, the disease can be life-threatening. Leishmaniasis is divided into three broad categories: mucocutaneous, visceral and cutaneous leishmaniasis. The cutaneous strain of the disease results in skin lesions ranging from a single, self-healing sore to a more widespread infection with skin ulcers that do not heal without treatment.
If you think you might have a skin ulcer, see a doctor immediately. Skin ulcers can attract an infection that spreads to nearby bones or connecting tissue. If this happens, it may mean the loss of the affected arm or leg, and can even be life-threatening.
During your appointment, your doctor will examine the wound, ask you about your personal and health history, and may order laboratory tests to help pinpoint the cause of the ulcer (if unknown) to create a treatment plan that’s right for you. The goal is to heal existing ulcers and minimize the chance of future ulcers forming.
Beyond fixing the underlying medical problem, treatment options include good wound care. Your doctor may recommend include applying wet dressings (only as directed), topical steroid creams or ointments to the sore, or taking oral antibiotics.
If you are attempting self-care, note that some topical skin care treatments can make the problem worse. Avoid antibiotic creams like neomycin or bacitracin, drying lotions like calamine, lanolin, and skin numbing products like benzocaine.