Pressure Sores

Some people get pressure sores during cancer treatment. Certain treatments, medicines (like chemo and steroids), and other factors increase this risk.

If you are at an increased risk of pressure sores, there are steps you can take to help prevent or treat them.

What are pressure sores?

Pressure sores appear as ulcers (open wounds) or crater-like areas on your skin. They can happen when a part of your body experiences a long period of excessive pressure that reduces blood flow and leads to skin damage.

The medical name for pressure sores is decubitus ulcers. Pressure sores are also called pressure injuries or pressure wounds.

What causes pressure sores?

Pressure sores can develop due to a combination of factors. The more factors you have, the higher your risk.

Pressure

Prolonged pressure on specific areas of your body reduces blood flow. This can lead to tissue damage. Pressure is higher on bony areas of the body because they aren’t protected by muscle or fat tissue. The most common areas include the hips, buttocks, heels, elbows, ears, and back of the head.

Shear

Shear happens when the skin moves in one direction while the underlying tissues move in another. For example, sliding down in a chair or bed causes shear. Shear damages your blood vessels and tissues, making your skin more vulnerable.

Friction

Friction happens when your skin rubs against another surface, like bedding or clothing. Friction weakens your skin’s protective barrier and contributes to pressure sore development.

Moisture

Damp or wet skin is more susceptible to damage. Bowel and bladder incontinence, sweating, and wound drainage can all increase moisture.

Risk factors

• Having an infection (even if not related to wound)
• Tobacco use
• Poor nutrition (malnutrition)
• Immobility (difficulty or inability to move or walk around)
• Diabetes and high blood sugar levels
• Vascular health conditions
• Certain cancer treatment and medicines (such as chemo and steroids)
• Staying in a hospital or nursing facility (these sores are called hospital-acquired pressure injuries, or HAPIs)

Having one or more risk factors can increase your risk for developing a pressure sore or injury.

Signs and symptoms

Most pressure sores start as an area of reddened skin that doesn’t go away even after removing the pressure. This can be a sign that there isn’t enough blood flow and oxygen getting to that area.

Other signs and symptoms include:

• Cracked, blistered, scaly, or broken skin
• An open sore on the skin’s surface or in the tissue under the skin
• Yellowish stains on clothing, sheets, or chairs (which may be tinged with blood)
• Painful or tender “pressure points”. For example, if you have pain when a bony area like your hips, shoulders, or elbows rests on a surface such as a chair or bed.

Treatment

Treatment for pressure sores is specific to each person. How your pressure sore is treated also depends on how severe it is and where it is on your body.

In general, treatment may include a combination of:

• Using wedges, cushions, and other positioning aids to reduce and redistribute pressure.
• Reducing friction and shear with special lifting sheets or devices, to be used when someone helps you reposition your body.
• Protecting your skin and reducing moisture with special powders, bandages, or other materials.
• Using nutritional supplementation to support wound healing.
• Treating with negative pressure wound therapy (often known as a wound vacuum device)
• Removal (debridement) of dead (necrotic) tissue.
• Preventing or treating infections with antibiotics.
• Taking steps to prevent stool or other body fluids from contaminating wounds.
• Visits in your home from a nurse to help manage your pressure sores.

Pressure injuries can develop in hours. That’s why it’s so important to tell your cancer care team or doctor if you have any signs or symptoms of a pressure sore.

Tips for preventing and managing pressure sores

Move around. Change positions frequently. If you’re in bed, shift at least every 2 hours (left side, back, right side). If you’re in a chair, shift every 15 minutes.

Use cushions. Special foam or gel seat cushions reduce pressure.

Choose comfortable clothing. Avoid tight or bunching clothing.

Protect pressure points. Use pillows to prevent new sores.

Consider a pressure-reducing mattress. Special pressure-reducing mattresses or foam layers can help, especially if you’re in bed for long periods of time.

Stay active. Take short walks 2 or 3 times a day. If you can’t walk, even moving your arms, legs, and hips in bed or a chair helps.

Eat high protein foods. Fish, eggs, milk, nuts, or peanut butter. If you’re not eating much, try protein drinks or foods to supplement.

Practice good skin care for sores. If you have a sore, tell your doctor or cancer care team. Take a photo of the area if you can. Ask them what to clean it with, and what type or bandages, ointments, creams, or powders to use.

When to contact your health care team

If you have a pressure sore, or if you are at high risk for one, make sure someone looks at your skin every day. Contact your health care team if you have:

• A reddened pressure area that isn’t getting better after repositioning
• Cracked, blistered, or broken skin
• A sore that is getting worse or bigger
• A sore with liquid, pus, or drainage
• Signs or symptoms of an infection without a known cause

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