Ulcers are the open wounds which appear on the skin on inside the body in the hollow organs which are painful and burn a lot and appear mainly because of reduced blood supply to the part of the skin or the organ.
They appear as open craters in the skin, are mostly round in shape - with an exception of highly advanced ulcers which have irregular shape - and have skin corroded in layers. The center most part is many a times the maximum corroded with the destruction of the epidermis, the dermis, the fat layer; the outer part curves towards the normal skin where the destruction is of the upper layer of the skin - the epidermis - with increasing involvement of the dermis and fat layer. The skin around the ulcer is red, tender to touch, painful and swollen.
Sometimes patient can feel pain around the ulcer and fluid oozes our from the ulcer and rarely he may also have fever if the ulcer is superseded with bacterial infection where pus formation takes place. Sometimes ulcer also bleed which can be in large quantity or sometimes in small clots.
Classification of Ulcers
Ulcers are classified according to the time which they require to heal. Ulcers are basically very slow in healing. If an ulcer heals in up to 12 weeks (3 months) time, then it is termed as Acute Ulcer. If an Ulcer takes more than 12 weeks times to heal, then it is known as chronic ulcer.
Stages of development of Ulcer
Ulcer formation first stage
The skin becomes red along with the soft underlying tissue.
Ulcer formation second stage
The redness of the skin becomes more and more pronounced and the part starts swelling. Slowly, one or two blisters appear on the swollen part and and the skin layers above the blisters stats to become dead and peel off.
Ulcer formation third stage
Now the area where the skin peeled off, becomes dead and straight downwards it becomes dead, which is known as necrosis of the skin. In such a dead skin area, the fat beneath this skin is exposed.
Ulcer formation fourth stage
More skin becomes dead deep till the fat layer is exposed more and more and destruction of the fat layer also starts. Muscles beneath the fat layer are also exposed.
Ulcer formation fifth stage
Destruction of the muscle layers initiate and above more fat and skin loss happens. Bones beneath the muscle layer are exposed.
Ulcer formation sixth stage - the final stage
Destruction of the bone can initiate and septic formation of the joints initiates. This condition is a serious condition.
Ulcers can reverse in any stage provided they get proper treatment, cleaning, dressing and medication.
Symptoms of Chronic Ulcers
Chronic ulcers are those in which there is ongoing destruction and no sign of recovery or very slow healing and where three months have passed but no healing is observed.
Chronic ulcers show the following appearances and complaints: -
- Constant pain at night and during the day
- Have increasing pain
- Friable granulation tissue
- Foul odor
- Wound breakdown instead of healing
- Symptoms worsen once the wound gets infected
Venous skin ulcers
Ulcers also appear at other prominent sites such as the veins. Such sites include areas around the veins of lower legs, the calf and the lower side of the ankle where the pressure of the whole body on the ankle joint is the maximum.
These ulcers cause the legs to ache a lot and are swollen. There are lot of chances that these ulcers would get infected and thus, they develop unpleasant odour, increased tenderness and redness.
The areas where a venous ulcer can develop, gets a dark red or purple skin above which the skin gets thickened, dried and gets a lot of itching.
People suffering from Diabetes have a higher concern of these Venous skin ulcers, as these people are at higher risk of developing diabetic neuropathy.
Other uncommon sites where ulcers can develop
Although rare, ulcers have developed at other sites such as cheeks, soft palate, the tongue, and on the inside of the lower lip. These ulcers are painful but are acute in nature and can heal in one or two weeks time.
Dr. Apurva Tamhane