What Are Skin Ulcers—And How Are They Treated?

A skin ulcer is a round, open sore or wound on your skin. An ulcer is a sign that minor skin injuries aren’t healing properly because of infection, inflammatory conditions, or blood circulation issues, whether due to a chronic disease or another health issue.  

While a small or mild skin ulcer isn’t necessarily dangerous on its own, it can become severe if not treated properly. 

Skin Ulcer Symptoms

It can sometimes be difficult to tell the difference between different types of lesions on the skin, but an ulcer is usually pretty specific-looking. These sores are typically: 

• Circular
• Crater-like
• Open
• Raw

In addition, you might notice: 

• Clear fluid, blood, or pus (when infected)
• A raised, inflamed, or discolored border
• Itching, burning, or pain

Also, keep in mind that skin ulcers will develop slowly and get worse over time as the skin tissue continues to break down.

What Causes Skin Ulcers?

Ulcers commonly happen when there’s a disruption to the body’s blood circulation. There are a couple of common underlying causes and risk factors that may make this more likely. 

Chronic Diseases

When you have a chronic disease like diabetes or atherosclerosis (an inflammatory disease of the arteries) that may interfere with the body’s healing process, ulcers are more common. These conditions can damage blood vessels, which means a lack of blood flow to certain areas and a decreased ability to heal skin wounds.

Pressure or Friction

Anything that causes constant pressure or friction on a certain body part can increase the chances of an ulcer forming. This typically happens when someone has limited mobility due to an injury, illness, or paralysis.

Pressure ulcers typically form when your skin is against a hard surface, like a bed or chair, for an extended period of time. The pressure reduces blood supply to the area that is against the hard surface, causing that skin to become damaged or die and leading to a pressure ulcer.

Venous Insufficiency 

Any health issues affecting the veins—whether it’s varicose veins or blood clotting—impacts the way that blood circulates throughout the body. Medically known as venous insufficiency, blood can pool in certain areas (like the legs, for example) when the veins are unable to push the blood to your heart. 

The added pressure of the blood in your legs’ veins, as well as the inability for oxygen to flow to affected skin tissue, can cause ulcers.

Risk Factors

Besides having certain conditions or mobility issues, there are other factors that can put you at increased risk for developing skin ulcers.

Groups more likely to develop an ulcer include:

• Older adults, because mobility can frequently be an issue
• People who smoke tobacco, as smoking slows wound healing
• Pregnant people, as pregnancy can sometimes cause changes to the body’s blood flow

Types of Skin Ulcers

There are several types of common skin ulcers. While all include having some type of circular, open wound, each type develops from a different underlying cause. 

Pressure Ulcer

Also called bedsores or decubitus ulcers, a pressure ulcer develops when there’s continued pressure on a certain area of your body. This pressure and friction compress the blood vessels underneath the skin and disrupt blood circulation, leading to a breakdown of skin tissue that’ll often become exposed and potentially infected. 

You may be more likely to get a pressure ulcer if you’re in a limited mobility situation where you’re confined to a certain position. They usually develop on bony parts of the body like the elbows, hips, back, tailbone, and ankles. 

Pressure ulcers are classified into four different groups based on how severe the sore is. In its most severe stage, a pressure ulcer can be so deep that it damages muscle, bone, tendons, and joints. 

Venous Ulcer

Venous ulcers most commonly form on the leg, above the ankle. They can occur when the veins aren’t circulating blood as well as normal. This causes a buildup of pressure, which eventually can prompt excess fluid and an open wound to develop. 

Factors like having varicose veins, sitting or standing for long chunks of time, or having a history of blood clots in the legs can increase the risk of developing venous ulcers. The risk also increases as you age. 

A venous ulcer typically has an uneven border around a shallow sore with a red base. Sometimes yellow tissue covers the sore. The skin around the sore may be shiny, tight, warm, or discolored. You also might experience leg pain.

Arterial Ulcer

Also known as an ischemic ulcer, an arterial ulcer may develop when there’s reduced blood flow to the feet or legs—usually due to artery damage. Any condition that compromises your circulation makes you more likely to develop arterial skin ulcers.  

These wounds usually develop on the legs, ankles, and toes, as well as between the toes. You may notice a raised edge around the wound, and the sore might be dark red, yellow, gray, or black.

Neuropathic Skin Ulcer

Neuropathic skin ulcers commonly develop in people with uncontrolled diabetes. In these cases, the sores are called diabetic ulcers. 

Neuropathic skin ulcers develop due to nerve damage. Nerve damage can make it hard for someone to know they have an injury because they do not feel the pain from the injury. In diabetes, this is called diabetic neuropathy. Because they don’t know they are injured, the injury can go untreated and lead to an ulcer. 

In diabetes, it is most common for ulcers to develop on the pads of your feet. 

Complications

Skin ulcers can have serious complications, especially if they start to affect deeper layers of the skin tissue. Some of the potential negative effects of skin ulcers include:

• Bacterial infection of the skin
• Bone infection
• Permanent scarring
• Skin cancer (squamous cell carcinoma) 

Ulcers can also cause you to lose a lot of fluid and protein, leading to low levels of protein in the blood (hypoproteinemia) or malnutrition. 

If left untreated, the best remedy for some ulcers might be amputation.

When to See a Healthcare Provider 

A healthcare provider should check any wound you suspect is an ulcer. You should make the visit a priority if the ulcer seems to be growing larger or is getting more painful.

Other red flags that may merit immediate medical attention include any signs of infection, such as:

• Redness, warmth, or swelling
• Severe pain
• Fever or chills
• Pus
• Odor
• An ulcer that is white, blue, or black 

Diagnosis

To confirm that what you have is an ulcer, a healthcare provider will first ask questions about your overall health and medical history. Then they will ask you specific questions about the initial lesion, how quickly the injury led to an ulcer, and whether you tried treating it in any way. To determine why the ulcer might have formed, the provider might also ask questions like whether you have ever experienced ulcers in the past or if you’ve had any recent procedures. 

From there, the provider will physically examine you. They should look not only at the ulcer itself but also at the surrounding skin and other areas that may help in the diagnosis, such as your mouth and nails. In general, a healthcare provider will likely be able to diagnose a skin ulcer by looking at the area.  

Most times, a provider can diagnose an ulcer just by looking at your skin and hearing about your medical history. Sometimes, they might use imaging tools such as computed tomography or ultrasound imaging to measure the wound’s size and depth. These imaging techniques can also be helpful in assessing blood flow, temperature, inflammation, and infection. 

If your spot is indeed diagnosed as a skin ulcer, it will be classified as acute or chronic. An acute ulcer is expected to heal within about 12 weeks. A chronic ulcer doesn't heal well after 12 weeks because the skin is unable to repair the area. This is the more serious type, as chronic ulcers are prone to potential complications like infection and pain.

Treatment Options 

Skin ulcers can take time to heal. Having the right treatment plan in place—and sticking to it—can help safely move along the healing process. 

Depending on the exact type of ulcer (and other factors like how severe the ulcer is and your overall health), your healthcare provider may recommend slightly different treatment options. 

Medication

If an ulcer is causing you pain, a healthcare provider may recommend some type of pain medication to help manage the pain. Depending on how severe your pain is, this can be an over-the-counter or prescription drug. A healthcare provider may also recommend antibiotics or immunosuppressants depending on the cause of the ulcer.

With an ischemic ulcer, you might also be prescribed medication to help get blood flowing in your leg.

Procedures

If the ulcer is severe, a medical procedure like one of the following might be advised: 

• Debridement: A procedure that involves removing dead skin tissue 
• A skin graft: The process of replacing damaged or dead skin with new, healthy skin tissue
• Amputation: The necessary surgical removal of an affected body part (like the leg or the foot) in extremely severe ulcer cases 

Dressings

Dressing an ulcer means keeping it covered. This can help keep an ulcer moist, clean, and infection-free to help support the healing process. Your healthcare provider can show you how to best apply and change your dressing.

While the dressing will keep the ulcer moist, the surrounding skin and the dressing itself should remain dry.

Keep in mind that some ulcers may need to remain uncovered for a period of time, particularly if they’re draining, so as not to slow down healing.

Blood Circulation Improvement

There are several healing techniques you can practice at home to help restore good blood circulation. These include:

• Wearing compression tights or sleeves 
• Propping up your feet when lying down
• Taking walks or exercising in some other way each day 
• Using items like mattress pads or foam cushions to reduce pressure
• Changing positions every two hours if you are in a bed

Prevention

If you have a condition that makes skin ulcers more likely or know that you're prone to developing them, it’s a good idea to schedule a visit with a healthcare provider to discuss this. They’ll be able to help you come up with a plan to help control any underlying causes of ulcers. 

If you know you are at risk for ulcers, you should also check your feet and legs every day for any sign of injury or ulcer.

To prevent pressure ulcers, make sure you are:

• Keeping your skin clean and dry
• Changing your position every two hours (or having someone do it for you if you are unable to do it yourself)
• Using products, such as pillows, to relieve pressure

If you are at risk for ischemic ulcers, try preventing them by:

• Wearing shoes and socks that fit well
• Avoiding sitting or standing for too long
• Protecting your feet from the cold
• Not walking barefoot
• Wearing compression stockings only when instructed (typically recommended for those with venous disease or arterial disease)
• Avoiding soaking your feet in hot water

To prevent venous ulcers, make sure you are keeping your lower legs’ skin moisturized.

Otherwise, to help reduce the chances of developing an ulcer, experts generally recommend implementing certain healthy lifestyle changes, such as:

• Quitting smoking
• Keeping chronic diseases like diabetes, high blood pressure, or high cholesterol under control 
• Exercising to maintain healthy blood flow 
• Eating a nutritious diet to support healing 

A Quick Review

Skin ulcers are round, open wounds that form on the skin when an injury or trauma is unable to heal properly. This often happens when there are blood circulation issues, whether it’s due to a chronic condition like diabetes or constant pressure on a certain part of the body after sitting or lying for an extended period of time. There are different types of ulcers, and each type may have different ways to prevent or treat them. As soon as you or a loved one notices that an ulcer has developed, you should start treatment. Early treatment can prevent complications from the ulcer.