Ulcer of the Skin – Skin Ulcer
An ulcer of the skin is a lesion in which an area of skin and a certain amount of underlying tissues has been destroyed. It differs from an ordinary wound in that the vitality of the tissue is less than normal and healing is delayed. The usual reasons for lowered tissue vitality are a reduction in blood or nerve supply or the presence of infection. Common manifestations of ulcers of the skin are as follows:
A. Bedsores (Trophic Ulcer, Decubitus Ulcer). This occurs in persons confined to bed or otherwise unable to change the position of some part of the body. The tendency is greatest in persons who have lost the normal skin sensations and who are therefore not impelled to make frequent changes of their position in bed. The ulcer develops because continuous pressure against an area (as from lying too long in the same position or because of a tight-fitting plaster cast) deprives the tissues of their normal amount of blood.
Bedsores occur in locations where the underlying parts of the skeleton are close to the skin, as over the bony prominences of the lower back, pelvis, and upper part of the hip, and in the vicinity of the ankle. Prevention requires cleanliness of the skin, gentle massage of the vulnerable areas with application of skin lotion or talcum powder, and frequent turning of the patient to new positions in bed. Once such an ulcer occurs, a doctor's supervision of the nursing care is in order.
B. Diabetes as a Cause of Ulcers of the Leg and Foot. Diabetes is often associated with arteriosclerosis (especially in persons above forty). The reduction of blood supply caused by the arteriosclerosis, plus reduced vitality of the tissues caused by the diabetes, causes the areas in the most dependent parts of the body (the feet and legs) to become subject to ulceration. The ulcer usually develops after local injury, often trivial.
C. Infected Ulcers. When skin wounds are infected by germs, healing is retarded and the unhealed area is properly called an ulcer.
D. Tropical Ulcers. In rural tropical areas, ulcers of the lower leg and foot are quite common. Some of these are caused by germs of yaws, leprosy, or diphtheria. Others-the so-called tropical ulcers-when once established, contain several kinds of germs. The fundamental cause of tropical ulcer is a protein deficiency which reduces the vitality of the tissues, permitting those in the dependent parts to break down when subjected to some minor injury.
E. Tuberculous Ulcers. When a tuberculous abscess, either of the soft tissues or of the bone, breaks through to the surface, the resulting lesion is slow to heal, constituting an ulcer or sinus. See chapter 38 for a consideration of tuberculosis.
F. Varicose Ulcers. Ulcers of the lower leg are a common complication of varicose veins. In varicose veins there is a stagnation of blood with consequent reduction of the vitality of the skin and subcutaneous tissues.
G. Venereal Disease Ulcers. In syphilis and in chancroid there usually develops a small ulcer at the site where the germs enter the tissues. This site is usually on the genital organs, although it can be on other parts. Skin ulcers may also appear in cases of untreated syphilis which progress to the second stage of the disease.
