What Are Bedsores (Decubitus Ulcers)? Skin Breakdown, Stages & Treatment Options

Bedsores, also called decubitus ulcers or pressure injuries, are areas of skin and soft-tissue damage caused by sustained pressure, shear, friction, or pressure from medical devices.

This page explains warning signs, body sites, stages, causes, risk factors, diagnosis, treatment options, prevention, mistakes, and urgent signs. Pressure relief is central to care because dressings or creams cannot work well while the same pressure source keeps damaging tissue.

What Are Bedsores and Why Are They Called Pressure Injuries?

Bedsores are pressure injuries, meaning localized damage to skin and underlying soft tissue caused by prolonged pressure, pressure with shear, or pressure from a medical device.

The modern term pressure injury is useful because damage can begin before the skin opens. A person may first notice discoloration, pain, warmth, firmness, sponginess, or a texture change over a pressure area.

Older terms such as pressure ulcer, pressure sore, and decubitus ulcer are still commonly used. The core problem is the same: tissue is being damaged by pressure, pressure plus shear, or device force.

Why Does Pressure Damage Skin and Deeper Tissue?

Pressure damages skin and deeper tissue by compressing blood vessels, reducing oxygen delivery, and lowering tissue tolerance until skin or soft tissue breaks down.

Body weight can press soft tissue between bone and a bed, chair, wheelchair, mattress, cushion, cast, brace, oxygen tubing, or other device. The bony prominence concentrates the force.

Shear adds risk when a person slides down in bed or a chair. Moisture, poor perfusion, poor nutrition, fragile skin, fever, severe illness, and reduced sensation can lower the skin’s ability to tolerate that force.

Why Is “Bedsore” Too Narrow?

“Bedsore” is too narrow because pressure injuries can happen in beds, chairs, wheelchairs, hospital settings, home care, or under medical devices.

Oxygen tubing, masks, braces, casts, splints, catheters, compression devices, wheelchair parts, and other equipment can create device-shaped pressure injuries. Prevention must happen wherever pressure occurs, not only in bed.

What Bedsore Warning Signs Show Early Skin Breakdown?

Early bedsore warning signs can include skin discoloration that does not blanch, warmth, firmness, sponginess, pain, itching, swelling, or texture change over a pressure area.

Blanching means a skin color change briefly fades when pressed and released. Non-blanching discoloration does not fade with pressure and can signal early tissue injury.

What Do Early Bedsores Look Like on Lighter and Darker Skin?

Early bedsores may look red or pink on lighter skin, while brown or black skin may look purple, blue, darker, shiny, or simply different from the surrounding skin.

Redness-only checks can miss early pressure injury in darker skin tones. Pain, warmth, coolness, firmness, bogginess, sponginess, swelling, itching, or a texture change can be as important as color.

What Warning Signs Suggest a Bedsore Is Getting Worse?

A bedsore may be getting worse when the area blisters, opens, drains, smells bad, becomes more painful, deepens, or develops yellow, black, or dead-looking tissue.

Yellow slough, black eschar, foul odor, pus, increasing drainage, exposed fat, tendon, muscle, or bone are not routine irritation. Do not cut away yellow or black tissue at home.

Where Do Bedsores Usually Form on the Body?

Bedsores usually form over bony areas where pressure is concentrated, especially when a person lies, sits, or uses medical devices for long periods.

Common pressure areas include the sacrum, tailbone, buttocks, hips, heels, ankles, elbows, shoulder blades, back of head, ears, spine, and knees. Device-related injuries can appear under oxygen tubing, masks, braces, casts, catheters, splints, or wheelchair equipment.

High-risk skin should be inspected daily because early changes can be subtle, especially on darker skin or under devices.

What Are the Stages of Bedsores?

Bedsores are staged by depth, tissue involvement, and wound appearance, and staging should be done by trained clinicians because it guides treatment.

Stages are not a home-diagnosis label from a photo. They help the care team match offloading, dressings, infection review, debridement, nutrition support, pain control, and specialist care to the wound.

What Is Stage 1 Pressure Injury?

Stage 1 pressure injury means the skin is still intact, but there is localized non-blanching discoloration or redness over a pressure area.

On darker skin, Stage 1 may not look red. It may appear purple, blue, darker, shiny, warmer, cooler, firmer, softer, painful, or different from nearby skin.

The priority is immediate offloading and protection. Stage 1 is not an open ulcer.

What Is Stage 2 Pressure Injury?

Stage 2 pressure injury means partial-thickness skin loss with exposed dermis, often appearing as a shallow open wound or serum-filled blister.

The wound bed may look pink or red and moist. Fat, slough, eschar, muscle, tendon, or bone should not be visible in Stage 2.

Stage 2 should not be used to label moisture damage, skin tears, burns, or abrasions that are not caused by pressure or shear.

What Are Stage 3 and Stage 4 Pressure Injuries?

Stage 3 and Stage 4 pressure injuries are deeper wounds that require professional wound care because full-thickness tissue loss is present.

Stage 3 means full-thickness skin loss; visible fat may be present, and slough, rolled edges, undermining, or tunneling may occur.

Stage 4 means full-thickness skin and tissue loss with exposed or palpable fascia, muscle, tendon, ligament, cartilage, or bone. These wounds have serious infection and deep-structure risk and should not be treated at home without wound-care support.

What Are Unstageable and Deep Tissue Pressure Injuries?

Unstageable and deep tissue pressure injuries need expert assessment because the true depth may be hidden or deeper damage may be present beneath intact or blistered skin.

Unstageable pressure injury means full-thickness damage is hidden by slough or eschar. Deep tissue pressure injury may appear as persistent deep red, maroon, purple discoloration, or a blood-filled blister.

Pressure injuries do not always progress neatly from Stage 1 to Stage 4, and healing wounds should not be described as moving backward through the stages. Stable heel eschar should not automatically be softened or removed without expert judgment.

What Causes Bedsores to Develop?

Bedsores develop when pressure, shear, friction, or moisture repeatedly stresses the same skin area and lowers the tissue’s ability to tolerate damage.

Pressure remains the central cause, but wounds often worsen because several risks act together: immobility, reduced sensation, moisture, fragile skin, poor circulation, poor nutrition, and device pressure.

How Does Pressure Cause Bedsores?

Pressure causes bedsores when body weight presses soft tissue between bone and a surface long enough to reduce blood flow and oxygen delivery.

This can happen in a bed, chair, wheelchair, operating table, hospital bed, home-care bed, or under a device. Tissue damage can begin before the skin opens.

How Do Shear and Friction Worsen Bedsores?

Shear and friction worsen bedsores when skin and deeper tissues are pulled, stretched, or rubbed during sliding, dragging, or repositioning.

Sliding down in bed or a chair can stretch deeper tissue layers while the skin stays against the surface. Dragging during transfers can rub fragile skin, especially at the heels and sacrum.

Lift or assist repositioning instead of dragging. Do not massage red, discolored, painful, or damaged pressure areas.

How Does Moisture Increase Bedsore Risk?

Moisture increases bedsore risk because sweat, urine, stool, or wound drainage can soften skin and make it break down faster under pressure or friction.

Incontinence-associated moisture damage can overlap with pressure injury, but moisture damage alone should not be staged as Stage 2 pressure injury. Care should address both moisture control and pressure relief when both are present.

Who Is Most at Risk for Bedsores?

Bedsore risk increases when someone has limited mobility, poor sensation, poor circulation, fragile skin, moisture exposure, poor nutrition, severe illness, surgery, medical devices, or a history of pressure injuries.

Risk is not a blame issue. A person can develop pressure injury because illness, immobility, surgery, wheelchair use, devices, frailty, or reduced sensation makes it difficult to shift pressure often enough.

• Limited mobility or bedbound status.
• Wheelchair use or long sitting time.
• Older age or fragile skin.
• Recent surgery or ICU stay.
• Spinal cord injury, stroke, paralysis, or reduced sensation.
• Diabetes, neuropathy, or vascular disease.
• Incontinence or frequent moisture exposure.
• Poor nutrition, dehydration, low body weight, or frailty.
• Obesity when pressure and immobility make care harder.
• Medical devices, braces, masks, tubing, casts, or splints.
• Previous pressure injury.

How Are Bedsores Different From Other Skin Wounds?

Bedsores are pressure-related injuries, while other wounds may be driven mainly by moisture, diabetes, poor vein return, poor artery flow, infection, burns, surgery, or trauma.

The cause and location matter because treatment changes. A wound over a pressure point needs offloading, while a venous, arterial, diabetic, traumatic, or infection-driven wound may require a different care plan.

How Are Bedsores Different From Moisture-Associated Skin Damage?

Bedsores are caused by pressure and shear, while moisture-associated skin damage is linked mainly to urine, stool, sweat, trapped moisture, or wound drainage.

Both can overlap. Skin exposed to urine or stool can break down faster under pressure, so prevention needs moisture control, barrier protection, and pressure relief together.

How Are Bedsores Different From Diabetic Foot Ulcers?

Bedsores are different from diabetic foot ulcers because diabetic ulcers often involve neuropathy and weight-bearing foot areas, while bedsores follow pressure-point or device-pressure logic.

Diabetes can also increase pressure-injury risk through neuropathy, circulation problems, and healing difficulty. Foot wounds in a person with diabetes need separate foot-care evaluation.

How Are Bedsores Different From Venous or Arterial Ulcers?

Bedsores are different from venous or arterial ulcers because pressure injuries follow pressure-site logic, while venous and arterial ulcers reflect circulation problems.

Venous ulcers often involve the lower leg or ankle with swelling and vein-related skin changes. Arterial ulcers may involve painful toes or feet, cool skin, poor pulses, and poor blood flow. Compression should not be used unless a clinician confirms it is appropriate.

How Are Bedsores Diagnosed and Assessed?

Bedsores are assessed by examining the skin, wound depth, stage, drainage, tissue type, pain, infection signs, nutrition, mobility, support surfaces, and the pressure source.

Staging and wound assessment should be clinician-led because depth, tissue type, infection risk, and pressure source determine the treatment plan.

What Does a Clinician Check in a Bedsore?

A clinician checks a bedsore by assessing its location, stage, size, depth, drainage, odor, tissue type, pain, surrounding skin, infection signs, and pressure source.

The care team may also review mobility, turning routine, mattress or cushion quality, device pressure, moisture exposure, nutrition, hydration, medical conditions, and caregiver support.

When Might Tests Be Needed?

Tests may be needed when a bedsore is infected-looking, non-healing, deep, recurrent, associated with poor nutrition, or suspected to involve bone or poor circulation.

Blood tests may review general health or nutrition when appropriate. A wound culture may be used when infection is suspected, but wounds can be colonized, so culture results need clinical interpretation.

Imaging may be considered if bone infection is suspected. Vascular assessment may be needed if circulation is poor. Stage 3, Stage 4, unstageable, deep tissue, recurrent, infected, heel, tunneling, or non-healing pressure injuries need wound-care specialist review.

• Location and pressure source.
• Stage or suspected depth.
• Length, width, and depth.
• Drainage amount and color.
• Odor.
• Slough, eschar, or exposed tissue.
• Undermining or tunneling.
• Pain level.
• Surrounding skin condition.
• Infection signs.
• Mobility and repositioning plan.
• Mattress, cushion, or device pressure.
• Nutrition and hydration status.

What Treatment Options Help Bedsores Heal?

Bedsore treatment usually involves reducing pressure, caring for the wound, controlling pain, preventing or treating infection, improving nutrition, and sometimes using advanced wound care or surgery for deep or non-healing ulcers.

The same wound dressing will not work well if pressure, shear, moisture, malnutrition, infection, or poor support surfaces are not addressed.

How Does Pressure Relief Treat Bedsores?

Pressure relief treats bedsores by removing the force that caused the injury, so the damaged tissue has a chance to recover.

Pressure relief may include repositioning, turning schedules, heel offloading, pressure-redistributing mattresses, wheelchair cushions, device repositioning, padding, and safer transfer methods that reduce friction and shear.

Offloading must continue after dressings are applied. A dressing does not replace pressure relief.

How Are Bedsore Wounds Cleaned and Dressed?

Bedsore wounds are cleaned and dressed based on wound depth, drainage, infection risk, and surrounding skin condition.

If the skin is not broken, gentle cleansing and protection may be used. Open wounds may be cleaned with water or saline when appropriate, and dressings are chosen to support a moist wound-healing environment while protecting the surrounding skin.

Dressing choices can include foam, film, gauze, hydrogel, alginate, hydrocolloid, or other dressings depending on depth, drainage, infection risk, and skin condition. Random creams that hide wound changes should be avoided.

When Is Debridement Needed for Bedsores?

Debridement may be needed when dead, damaged, or infected tissue blocks healing, but it should be done by trained clinicians rather than attempted at home.

Slough or eschar can hide wound depth or infection risk. Clinicians may select sharp, mechanical, enzymatic, autolytic, or other methods based on the wound. Stable heel eschar needs expert judgment.

Do not cut, scrape, peel, or pull away dead tissue at home.

When Are Antibiotics, Advanced Wound Care, or Surgery Used?

Antibiotics, advanced wound care, or surgery may be needed when a bedsore is infected, deep, non-healing, recurrent, or large enough that standard wound care is not enough.

Antibiotics are not for every pressure injury. They may be needed for spreading infection, cellulitis, bacteremia, osteomyelitis, or other clinician-confirmed infection contexts.

Advanced wound care, negative pressure wound therapy in selected clean wounds, or flap surgery may be considered for some large, deep, or non-healing ulcers. Offloading and nutrition still must be addressed for advanced care to work.

How Do Nutrition and Hydration Support Bedsore Healing?

Nutrition does not replace offloading or wound care, but poor nutrition and dehydration can delay bedsore healing and increase the risk of further skin breakdown.

Wound healing needs enough protein, calories, fluids, and vitamins or minerals when a deficiency is present. People with weight loss, low body weight, poor appetite, swallowing problems, diabetes, kidney disease, or deep wounds may need an individualized plan.

A dietitian can help when wounds are deep, recurrent, slow-healing, or linked with poor intake. Supplements should not be treated as a cure without clinical assessment.

• Protein intake reviewed.
• Calories adequate for healing needs.
• Fluid intake reviewed.
• Vitamin or mineral deficiencies checked when suspected.
• Weight loss or low body weight addressed.
• Poor appetite or swallowing problems discussed.
• Diabetes, kidney disease, or other conditions considered.
• Dietitian involved for deep, recurrent, or slow-healing wounds.

How Can Bedsores Be Prevented or Stopped From Getting Worse?

Bedsore prevention depends on regular repositioning, support surfaces, daily skin checks, moisture control, activity when possible, medical-device checks, and adequate nutrition.

Change position regularly based on the person’s risk, surface, mobility, and care plan. Use pressure-redistributing mattresses or cushions when needed, but do not treat support surfaces as a replacement for repositioning.

Offload heels, protect bony areas, keep skin clean and dry, manage urine, stool, sweat, and drainage moisture, and avoid dragging during transfers. Check oxygen tubing, masks, braces, casts, catheters, splints, and wheelchair equipment for pressure marks.

• Change position regularly.
• Use pressure-redistributing mattresses or cushions when needed.
• Offload heels.
• Keep skin clean and dry.
• Manage urine, stool, sweat, and drainage moisture.
• Inspect high-risk skin daily.
• Avoid dragging during transfers.
• Check oxygen tubing, masks, braces, casts, catheters, and splints.
• Encourage safe movement when possible.
• Maintain nutrition and hydration.
• Ask for a formal risk assessment when care is happening at home.

What Bedsore Mistakes Should You Avoid?

The biggest bedsore mistake is putting cream on the sore while leaving the same pressure, shear, moisture, or device problem in place.

Do not keep pressure on the sore. Do not massage red, discolored, painful, or damaged pressure areas. Do not use donut cushions by default because they can concentrate pressure unless a clinician specifically advises them.

Do not cut away dead tissue at home. Do not apply random antibiotic creams, harsh antiseptics, powders, bleaching products, or wound products that hide the wound from assessment.

When Should Bedsores Be Checked Urgently?

Bedsores need urgent care when there is pus, hot or swollen skin, spreading redness or purple/blue discoloration, high temperature, severe or worsening pain, foul odor, rapidly worsening tissue damage, black tissue with inflammation, or exposed deeper structures.

Urgency is higher in older, frail, immobile, diabetic, immunosuppressed, spinal-cord-injured, poor-circulation, or severely ill people because infection and deeper tissue damage can become serious.

Which Infection Signs Need Urgent Medical Review?

Infection signs that need urgent medical review include pus, foul odor, increasing drainage, spreading warmth, swelling, redness or purple/blue color change, fever, chills, confusion, or severe worsening pain.

A pressure injury with spreading warmth, swelling, pain, fever, or rapidly expanding redness may need evaluation for cellulitis or another bacterial complication.

Black tissue with surrounding redness, drainage, or pain should be treated as a warning sign, not a normal scab.

Which Bedsore Features Need Wound-Care Specialist Review?

Wound-care specialist review is needed for Stage 3, Stage 4, unstageable, deep tissue, heel, recurrent, tunneling, undermined, infected, exposed-tissue, or non-healing pressure injuries.

Specialist review is also important when a wound is not improving despite offloading, or when the person has diabetes, poor circulation, immune suppression, spinal cord injury, severe frailty, exposed fat, tendon, muscle, or bone.

What Should You Remember About Bedsores?

The most important thing to remember about bedsores is that they are pressure injuries, so the central treatment logic is pressure relief first, then stage-appropriate wound care, infection control, nutrition, and prevention.

Early discoloration, pain, warmth, firmness, sponginess, or texture change over a pressure area should not be ignored. Open, deep, infected, unstageable, recurrent, heel, or non-healing pressure injuries need professional care.

• Bedsores are also called decubitus ulcers, pressure ulcers, or pressure injuries.
• They usually develop over bony areas or under medical devices.
• Early signs can be color, temperature, firmness, pain, itching, or texture changes.
• Redness-only checks can miss early pressure injury on darker skin.
• Staging guides treatment and should be clinician-led.
• Offloading is not optional.
• Dressings do not work well if pressure continues.
• Deep, infected, unstageable, recurrent, or non-healing wounds need professional care.
• Prevention requires repositioning, support surfaces, skin checks, moisture control, device checks, and nutrition.

Frequently Asked Questions About Bedsores