Stage 1 sores are not open wounds. The
skin may be painful, but it has no breaks or tears. The skin appears reddened and does not blanch (lose color briefly when you press your finger on it then remove your finger). In a dark-skinned person, the area may appear to be a different color than the surrounding skin, but it may not look red.
Skin temperature is often warmer. And the stage 1 sore can feel either firmer
or softer than the area around it.
At stage 2, the skin usually breaks open, wears away, or forms an ulcer, which is
usually tender and painful. The sore expands into deeper layers of the skin. It
can look like a scrape (abrasion) or a shallow crater in the skin. Sometimes
this stage looks like a blister filled with clear fluid. At this stage, some
skin may be damaged beyond repair or may die.
During stage 3, the sore gets worse and extends into the tissue
beneath the skin, forming a small crater. Fat may show in the sore, but not
muscle, tendon, or bone.
At stage 4, the
pressure injury is very deep, reaching into muscle and bone and causing extensive
damage. Damage to deeper tissues, tendons, and joints may occur.
In stages 3 and 4 there may be little or no pain due to
significant tissue damage. Serious complications, such as infection of the bone (osteomyelitis) or blood (sepsis), can
occur if pressure injuries progress.
Sometimes a pressure injury does
not fit into one of these stages.
In some cases, a deep pressure injury is suspected but can’t be
confirmed. When there isn’t an open wound but the tissues beneath the surface
have been damaged, the sore is called a deep tissue injury (DTI). The area of
skin may look purple or dark red, or there may be a blood-filled blister. If you or
your doctor suspects a pressure injury, the area is treated as though a pressure
injury has formed.
There are also pressure injuries that are
“unstageable.” This means that the stage is not clear. In these cases, the base of
the sore is covered by a thick layer of other tissue and pus that may be
yellow, gray, green, brown, or black. The doctor cannot see the base of the
sore to determine the stage.
ByHealthwise Staff Primary Medical ReviewerE. Gregory Thompson, MD – Internal Medicine Adam Husney, MD – Family Medicine Kathleen Romito, MD – Family Medicine Specialist Medical ReviewerMargaret Doucette, DO – Physical Medicine and Rehabilitation, Wound Care, Hyperbaric Medicine