The different types of pressure ulcer
Pressure ulcers are classified by stage according to their severity⁽¹⁾.
Category 1: Non-blanching erythema
Redness on intact skin which does not become white when short-term pressure is applied. Discolouration of the skin, warmth, oedema, induration or hardness, area may be painful. There is no wound present.
Category 2. Partial thickness skin loss with exposed dermis
This stage presents deterioration of the skin reaching the epidermis and dermis. There is an open ulcer with a red pink wound bed. The ulcer appears superficial and presents clinically as an abrasion or blister (intact or ruptured).
Category 3: Full-thickness skin loss (fat visible)
The epidermis, dermis and subcutaneous layers are affected. The presence of necrotic (black) and sloughy (yellow) tissue may be observed, however, they don not obscure the depth of tissue loss.
Category 4: Full-thickness tissue loss (bone, tendon or muscle visible)
The stage presents a wound with exposed bone, tendon or muscle. Slough or black necrosis (eschar) may be present on some parts of the wound bed. The wound often includes undermining and tunnelling.
2 other categories are mentioned by the international NPUAP/EPUAP pressure classification system
Unstageable: Depth Unknown
The wound bed of the ulcer is covered by slough and / or black necrosis (eschar). Until enough slough and / or eschar is removed to expose the base of the wound, the true depth, and therefore the category. cannot be determined. Eschar on the heels should not be removed, without full vascular assessment.
Suspected Deep tissue Injury. Depth Unknown
Presence of purple or brown area of discoloured, intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and / or shear. The area may be preceded by tissue that is painful, firm, warmer or cooler compared to adjacent tissue.
DID YOU KNOW? Pressure ulcers - location
In 80% of cases, pressure ulcers appear in the sacrum or heel. They are the main areas of support for patients with reduced or no mobility. This wound can also appear on the elbows, shoulders blades, or the back of the head.
- NationalPressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and PanPacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers:Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Osborne Park,Australia; 2014.