Topic Overview

Pressure injuries are described in four

  • 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.

Related Information


ByHealthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD – Internal Medicine
Adam Husney, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Margaret Doucette, DO – Physical Medicine and Rehabilitation, Wound Care, Hyperbaric Medicine

Current as ofJune 7, 2017