Encyclopedia of Health and Medicine

dermatitis 149
Symptoms and Diagnostic Path
The symptoms of decubitus ulcer depend on its
stage of development. Health-care providers classify
decubitus ulcers on a scale of 1 to 4, with
stage 1 being the slightest level of damage and
stage 4, the most significant. PAIN is not an effective
measure of a decubitus ulcer’s severity as the
damage to the skin and underlying tissues may
destroy NERVE endings. Doctors diagnose a decubitus
ulcer on the basis of its appearance.
Treatment Options and Outlook
The first and most urgent action in treating decubitus
ulcers is to relieve all pressure on the area.
This may include using pillows, cushions, pads,
and other items to support the body in positions
that do not put pressure on or near the ulcer.
Additional treatment may include regularly
cleansing the ulcer to prevent INFECTION, or ANTIBI-
OTIC MEDICATIONS to treat infection that already
exists. Deep ulcers (stage 3 and especially stage 4)
often require surgical débridement (removing
dead and damaged tissue under anesthetic).
Recovery depends on the stage of the ulcer and
the general health condition of the person. With
early and aggressive intervention, recovery can be
complete with minimal permanent tissue damage.
Stage 2 and stage 3 ulcers generally heal with
some loss of tissue and scarring. Stage 4 ulcers are
extensive wounds that may require multiple
débridements and long-term treatment by a
WOUND CARE specialist. When debilitation is longterm
or permanent, the risk for recurring decubitus
ulcers is high.
Risk Factors and Preventive Measures
People whose health conditions limit their ability
to move parts of their bodies or confine them to
wheelchairs or bed have very high risk for decubitus
ulcers. Preventive measures include
• position changes every two hours when in bed
and every 15 minutes when sitting in a chair or
wheelchair
• air mattress with alternating compartments or
air flotation mattress
• eggshell mattress or seat cushion
• sheepskin pads over bony protuberances such
as the heels and elbows
• active movement at least four times a day
when possible and passive range of motion
exercises when active movement is not possible
• frequent (at least daily) inspection of areas vulnerable
to pressure
• diligent skin hygiene, including daily cleansing
and complete drying
Prompt intervention at the earliest signs of a
decubitus ulcer can prevent extensive or permanent
tissue damage.
See also AGING, INTEGUMENTARY CHANGES THAT
OCCUR WITH; CELLULITIS; EPIDERMOLYSIS BULLOSA; GAN-
GRENE; SCAR; SPINAL CORD INJURY; TRAUMATIC BRAIN
INJURY (TBI).
dermabrasion A mechanical method for
smoothing roughened or scarred SKIN. The dermabrader
is a motorized burrlike device that
“sands” away the layers of skin to achieve the
desired result. Dermabrasion is appropriate for
treating skin blemishes such as ACNE scarring or
sun damage. The dermatologist administers a
sedative and a local anesthetic before the procedure.
After the procedure the skin is raw and tender.
There is usually significant swelling and
moderate discomfort that requires PAIN relief medication.
The skin scabs in about 24 to 36 hours. As
HEALING progresses, the scabs fall off, with the new
skin pink and shiny beneath. Total healing is complete
in five to six months, though most people
can return to their regular activities in about three
weeks. Risks and complications of dermabrasion
include bleeding, INFECTION, scarring, and occasionally
KELOID (overgrown SCAR) formation. Proper
postprocedure care is important to encourage
appropriate healing.
See also BOTULINUM THERAPY; CHEMICAL PEEL; LASER
SKIN RESURFACING; PLASTIC SURGERY.
dermatitis INFLAMMATION, redness (erythema),
and itching of the SKIN. Dermatitis has many
causes and manifests in numerous and varied presentations,
some of which may reflect conditions
such as viral INFECTION, AUTOIMMUNE DISORDERS, and
certain kinds of CANCER. Dermatitis may be acute
(come on suddenly) or chronic (persist or recur
over an extended period of time).