A skin or pressure sore develops when the blood supply to an area of the body is stopped and the skin in that area dies, often leaving an open crater or ulcer in the skin. A person who is bedridden or always in a wheelchair puts pressure on the same places much of the time. This reduces the blood flow to these places, making them more likely to develop open sores. These areas are made worse when sheets rub against them or the patient is roughly pulled up in the bed or chair.
What to look for
- 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 (may be tinged with blood)
- Painful or tender “pressure points” (such as on the back of the head, ears, back of shoulders, elbows, buttocks, hips, heels, or any place a bony part rests on the bed surface)
- Red pressure points on the skin that don’t go away even after the pressure is removed (can be an early sign that skin is about to break down or die)
What the patient can do
- Change your position at least every 2 hours from your left side, to your back, to your right side.
- In a wheelchair, shift your weight every 15 minutes. Use special foam or gel seat cushions to reduce pressure.
- Choose clothing that isn’t too tight or so loose that it bunches up under you.
- Protect other “pressure points” with pillows to help prevent new sores. If possible, use a pressure-reducing mattress or 3- to 4-inch foam layer over your mattress.
- Exercise as much as possible. Try to take a short walk 2 or 3 times a day. If you can’t walk, pull up, and move your arms and legs up and down and back and forth.
- Eat foods high in protein (such as fish, eggs, meats, milk, nuts, or peanut butter).
- Increase fluids. (If you’re not eating well, try high-calorie liquids such as milkshakes or canned liquid food supplements.)
- Always protect the sore and the area around it with a foam wedge or pillow.
- Rinse any open sore with water very carefully and cover with a bandage. Do this every time the bandage gets soiled, or at least twice a day as instructed. If you’re given ointments or creams, use them as directed. Report any itching, blistering, new drainage, or increase in size of the sore to your cancer team.
What caregivers can do
- Remind the patient to change positions often, or help the patient turn every 2 hours.
- If the patient can’t control their bowels and bladder, change their underwear as soon as you notice soiling. After cleaning, apply an ointment (such as A+D ointment) to keep the area dry. Sprinkle cornstarch over the ointment. Use underpads to keep the patient from soiling the bed and to make it easier to clean up. Don’t use plastic underwear unless the patient is out of bed.
- If the skin has an open sore, ask about special dressings to help protect it.
- If the patient can’t get out of bed:
- Keep the bottom sheets pulled tight to prevent wrinkles.
- Keep the head of bed flat or no higher than a 30° angle.
- Sprinkle sheets with cornstarch to reduce friction from rubbing against them.
- Check the patient’s back and sides each day to be sure that the skin looks normal. Pay special attention to pressure areas such as the tailbone, hipbones, knees, ankles, heels, shoulders, and elbows.
- If you notice a reddened “pressure area” (an area that stays red after pressure is taken off it), keep the pressure off it as much as you can to try to prevent further breakdown. Use pillows and have the patient change position often.
- If the patient has trouble staying on their side, ask about foam wedges to help hold positions.
- Ask your cancer team if you can get a home health nurse to visit and help you make a plan to care for and prevent further skin problems.
- Ask if you can get foam, gel, or air cushions for the bed and chairs. Find out about special beds that help reduce pressure.
Call the cancer team if the patient:
- Has cracked, blistered, scaly, or broken skin
- Has a sore that’s getting bigger
- Has a thick or bad-smelling liquid draining from the sore
- Needs help from a home care agency for wound care and supplies
Fauci AS, Braunwald E, Kasper DL, et al (Eds). Harrison’s Principles of Internal Medicine, 17th ed. New York: McGraw-Hill Medical, 2008.
Camp-Sorrell D, Hawkins RA. Clinical Manual for the Oncology Advanced Practice Nurse, Second Ed. Pittsburgh: Oncology Nursing Society, 2006.
Cope DG, Reb AM. An Evidence-Based Approach to the Treatment and Care of the Older Adult with Cancer. Pittsburgh: Oncology Nursing Society, 2006.
Houts PS, Bucher JA. Caregiving, Revised ed. Atlanta: American Cancer Society, 2003.
Kaplan M. Understanding and Managing Oncologic Emergencies: A Resource for Nurses. Pittsburgh: Oncology Nursing Society, 2006.
Kuebler KK, Berry PH, Heidrich DE. End-of-Life Care: Clinical Practice Guidelines. Philadelphia: W.B. Saunders Co. 2002.
National Comprehensive Cancer Network. Palliative Care. Version 1.2015. Accessed at www.nccn.org/professionals/physician_gls/pdf/palliative.pdf on March 19, 2015.
Oncology Nursing Society. Cancer Symptoms. Accessed at www.cancersymptoms.org on April 3, 2013.
Ripamonti C, Bruera E. Gastrointestinal Symptoms in Advanced Cancer Patients. New York: Oxford University Press, 2002.
Varricchio CG. A Cancer Source Book for Nurses, 8th ed. Sudbury, MA: Jones and Bartlett, 2004.
Yarbro CH, Frogge MH, Goodman M. Cancer Symptom Management, 3rd ed. Sudbury, MA: Jones and Bartlett, 2004.
Last Medical Review: June 8, 2015 Last Revised: May 17, 2016