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Stage-2 Pressure Ulcers - Causes, Symptoms, Treatment, And Prevention

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A stage 2 pressure ulcer is characterized by partial loss of skin thickness with blister formation in areas where pressure is applied over a long time.

Written byDr. Mythlee Chitra. S

Medically reviewed byDr. Dhepe Snehal Madhav

Published At September 9, 2022
Reviewed AtJune 19, 2024

Introduction:

Pressure ulcers, bedsores, or decubitus ulcers, are injuries to the skin and its underlying tissue caused by continued pressure on the skin. In stage 1 pressure ulcer, the ulcer has a red, blue, or purple tint and feels warm to the touch, burning, and itchy. If a stage 1 pressure ulcer is not treated correctly on time, it may develop into a stage 2 pressure ulcer. At this stage, the pressure ulcer breaks the superficial skin layers resembling an open blister, causing pain and discoloration. Pressure ulcers are common in patients with limited mobility or underlying medical problems. Untreated stage 2 pressure ulcers can worsen, causing severe medical problems, or may be fatal. Proper medical care can help elders to recover. Stage 2 pressure ulcers may indicate nursing care abuse or neglect.

What Are the Various Stages of Pressure Ulcers?

The stages of pressure ulcers are as follows:

  • Stage 1: The skin appears red without any open wound. In dark-colored people, the change in skin color is hard to see. The skin appears tender to the touch, firm, cool, warm, or soft.

  • Stage 2: It appears as a shallow wound with a red or pink base. Blisters, skin loss, and abrasion can be seen.

  • Stage 3: The visible wound may go into the hypodermis or fatty layer of the skin.

  • Stage 4: This is an aggressive stage where the wound penetrates into all the skin layers and exposes the muscles, tendons, and bones of the musculoskeletal system.

What Are the Symptoms of Stage 2 Pressure Ulcers?

Stage 2 pressure ulcers are open, shallow, broken wounds with a red base. Intact or incompletely ruptured blisters may also be present with clear fluid or pus seeping from the affected area, and the skin adjacent to it may be discolored. It may involve both the dermis and epidermis of the skin.

Stage 2 bedsores are common in ankles and heels, back of the head, hip, shoulder blades, and tailbone. However, it can develop in any part of the body under constant pressure. Still, areas near bones are at a higher risk.

There is more significant pain in stage 2 bedsores than in stage 1 bedsores. The pain decreases as the sore worsens but becomes harder to treat, leading to fatal complications.

What Are the Causes of Stage 2 Pressure Ulcers?

Pressure ulcers can occur mainly due to three different forces:

  • Prolonged Pressure - When a person applies constant pressure against the bony surface for a long time, it can result in a pressure ulcer. When this pressure goes beyond the tissue capillary pressure, the surrounding tissues are deprived of oxygen, leading to tissue necrosis.

  • Shearv - Shear happens when the deep fascia slides over the skeletal muscle, which can compress the blood vessels leading to ischemia and tissue necrosis.

  • Friction - Friction is the opposite of shear force. Friction causes microscopic and macroscopic tissue trauma when the patient moves through the support surface.

Further, moisture from incontinence, wetness, or exudate increases the friction between the surface and the skin. It weakens the epithelial bonds making the skin more liable to pressure, shear, and friction damage.

Stage 1 pressure ulcers do not cause skin breaks, but disposing of the same area to any forces after an ulcer is formed can tear the skin, developing stage 2 pressure ulcers.

Which Body Parts Are Mostly Affected by the Bed Sores?

Bed sores can occur anywhere in the body, but are most likely to develop where bone and skin are in close contact with each other. It usually affects the following body parts:

  • Buttocks.

  • Ankles.

  • Heels.

  • Back.

  • Elbows.

  • Tailbone.

  • Hips.

Who Is at Risk for Stage 2 Pressure Ulcers?

Patients with limited mobility, immobility, and bedridden patients. Elders with medical conditions like circulatory diseases and diabetes (high blood sugar), atherosclerosis (cholesterol and fat build-up in and on the walls of the artery), spinal cord injury, neuropathy (nerve damage causing numbness and pain), and infections. Patients who lack control over urination and defecation moisten the adjacent skin and damage the skin. Additionally, adult diapers trap waste, thus damaging skin if they are not changed frequently. Malnourishment causes anemia (lack of enough healthy red blood cells in the blood) that can decrease a person's health and weight, which results in bedsores.

How Is a Stage 2 Pressure Ulcer Treated?

Dressing over the ulcer keeps the ulcer dry and decreases the risk of infection.

Different dressings available in the market are:

  • Topical antimicrobials include Bacitracin, Bactroban, Cadexomer iodine, nanocrystalline silver, polysporin powder, silver sulfadiazine cream, silver-impregnated hydrofiber, silver gel, and sodium hypochlorite.

  • Alginates dressing.

  • Barrier dressings.

  • Activated charcoal dressings.

  • Collagen dressing.

  • Composite products.

  • Compression wraps.

  • Hydrophilic polyurethane foams.

  • Cotton, rayon, or polyester gauze packs.

  • Carboxymethylcellulose (CMC) combined with pectin hydrocolloids.

  • Carboxymethylcellulose hydrofiber.

  • Hydrogels.

  • Sodium chloride impregnated dressings.

  • Petrolatum-impregnated dressings.

  • Polyurethane or synthetic polymer sheets transparent films.

Aggressive irrigation with saline solution is done to clean the open wound. The damaged and dead tissues are debrided from the ulcer to promote healing. Nutritious vitamins A and C, protein, zinc, and iron-rich diets should be given. Enough water intake also plays an essential role in healing. Reducing pressure on the ulcer area will prevent it from worsening and allow the skin to repair. Negative pressure wound therapy uses sub-atmospheric pressure to stimulate wound contraction, remove discharges, reduce swelling, and increase blood flow.

How to Prevent Stage 2 Pressure Ulcers?

Stage 2 pressure ulcers can be prevented when stage 1 pressure ulcers are treated early. Treatment includes removing pressure from the ulcer and keeping it clean and dry. Consult a physician if the ulcer does not fade in two to three days.

  • The patient should be repositioned every two hours.

  • Maintain the skin clean and dry.

  • Do not massage the bony prominences.

  • Use positioning devices to avoid continued pressure over the bony prominences.

  • Keep the bed head as low as possible to decrease the risk of shearing.

  • Keep bedspreads dry and without fold.

  • Use a pillow between the legs when lying on the sides.

  • Do not directly position the trochanter.

What Is the Prognosis of a Stage 2 Pressure Ulcer?

Stage 2 pressure ulcers have a relatively good prognosis when treated on time. They usually heal in three days to three weeks when appropriately treated.

What Are the Complications From Stage 2 Pressure Ulcers?

Stage 2 pressure ulcers, when left untreated, can advance into deeper skin tissues, resulting in stage 3 and 4 ulcers which are harder to treat and may be fatal. Infection in pressure ulcers can spread to the blood and bones, resulting in sepsis and osteomyelitis. When deeper tissues are involved, it may cause permanent tissue damage that may never heal completely even with treatment. Pressure ulcers increase the risk of urinary tract infections (UTIs), amputations, and autonomic dysreflexia (stimulation causing abnormal overreaction autonomic nervous system).

Conclusion:

Stage 2 pressure ulcers are open wounds on the epidermis of the skin. Proper care given when the stage 1 pressure ulcer is diagnosed can prevent progressing to stage 2 pressure ulcers. Frontline caregivers play an essential role in screening, assessing, and managing pressure ulcers. Healing and prevention of pressure ulcers in critically ill patients are crucial. Early referral and treatment improve the outcome of the risk of pressure ulcers.

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Frequently Asked Questions

Management of stage 2 ulcer includes the following
Bandaging:
- This prevents the risk of infection by keeping the ulcer wound dry.
Cleaning:
- The wound is cleaned by rinsing the saline over it.
Debriding:
- This procedure involves eliminating damaged tissue with the help of a professional.
Reducing the pressure:
- Removing the pressure over the ulcer prevents it from worsening and helps heal.
- Adequate nutrition:
- Malnutrition is a risk factor for pressure ulcers; this is why people with bedsores should be enriched with vitamins and minerals that enhance the body's repair process.
Stage 2 ulcers are open wounds where the skin breaks open tears away to form a painful ulcer. The ulcer wound moves to the deeper layers of the skin. This looks like blisters, abrasions, or shallow craters on the skin's surface.
Stage 1 Ulcer:
This type of ulcer is formed only over the outer layer of the skin called the epidermis, which remains unbroken. 
Stage 2:
In stage 2, the ulcer wound breaks open on the layer of the epidermis and a layer below. It appears as shallow blisters or crater wounds.
Stage 3:
When the ulcer wound reaches stage 3, it invades beyond the layers of the skin and reaches the fatty tissues. The risk of infection is greater at this stage.
Stage 4:
It is a serious condition where the ulcer invades beyond the tissue layer into the muscle and ligaments and even sometimes to the bone.
Stage 2 ulcer is a condition where the ulcer wound moves deep into the epidermis resulting in a break-open of the skin. The ulcer at this stage appears to as blisters, caters, or open wound. Healing of this ulcer takes time up to three days to three weeks, depending on the extent and severity of the ulcer.
Stage 2 pressure ulcer causes the opening of the wound, which may take time to get completely cured. This condition may take three days to three weeks to heal, depending on the extent and severity of the ulcer wound.
Antibiotics are not regularly required to treat bed sores. Antibiotics are prescribed when there is an infected pressure ulcer and are used to prevent the spreading of infection. Antiseptic cream can be used over the pressure ulcer. Topical mupirocin and oral antibiotics are recommended to treat infected bed sores.
Stage 2 ulcer results in an open wound where the skin breaks out and forms an ulcer. This sort of ulcer usually causes pain. These ulcers invade deep into the skin which resembles like blister or abrasion. 
Stage 4 is considered to be the last stage of the ulcer. In this stage, the ulcer invades the epidermis and reaches the muscles and, in some cases, the bone. This ulcer has an increased risk of infection and is very difficult to treat. The ulcer wound can be filled with pus which occurs due to damage to the nerves, muscles, tendons, and tissues. 
There are many non-healing ulcers that cannot be cured through treatment or medication; some are 
- Venous arterial.
- Diabetic.
- Traumatic.
- Pressure ulcers. 
Some of the ulcers can be healed by themselves without any treatment. Even if the ulcer heal on its own, the warning signs and symptoms should not be ignored, as they can result in severe health issues like bleeding, perforation, etc.
Pressure ulcers can be cured at a fast pace by
Cleaning:
If the skin is not open, it can be cleaned using a cleanser. Where the skin is broken, saline water can be used to clean the wounded area, and the site is dried.
Bandage:
Putting on a bandage is necessary as it fastens the healing process and prevents form occurrence of any infection.
Pressure ulcers are usually painful and tender. The healing process of these ulcers depends on the extent and severity. The pain may usually last weeks up to months, depending on the severity of the ulcer. 
Sopem people massage over the area of bony prominence and pressure area to prevent the occurrence of the ulcer. But there is no proper evidence of massaging that can prevent ulcers. So it is advisable to avoid massaging. 
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Dr. Dhepe Snehal Madhav from iCliniq
Dr. Dhepe Snehal Madhav

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