grandfather eating in bed risk for skin breakdown needs prevention from wife and daughter

Skin Breakdown Can Be Serious! Tips for Prevention

Although our skin is generally resilient, skin breakdown is a risk for those subjected to prolonged pressure, friction, moisture, or shear force. Skin breakdown prevention and identifying concerns early are essential because skin breakdown can quickly progress from minor to serious. You may have heard terms like pressure ulcer, bed sores, or skin shearing, which all relate to skin breakdown.


What is Skin Breakdown?

Our skin is important because it protects our body from infection, helps our body maintain the appropriate body temperature, and allows us to feel hot, cold, pain, and other stimulation.

The skin is the largest organ and receives one-third of our body’s blood circulation.

This blood flow helps keep our skin healthy.

Skin breakdown occurs when our skin or underlying tissue, including muscle or bone, becomes damaged because of loss of blood flow to that particular area.

Not only can skin become damaged, but ulcers can develop. 



Skin breakdown is frequently also called

  • Pressure ulcer

  • Bedsore

  • Decubitus

  • Pressure sores

  • Ulcer


Pressure ulcers usually occur when continuous pressure on the part of your body cuts of the circulation from small blood vessels in the skin.

If our skin does not get enough nutrients and oxygen for too long, the tissue can die, and pressure ulcers may develop.



Risks for skin breakdown include:

  • Decreased sensation, so one cannot feel continued pressure or skin breakdown forming
  • Inability or decreased ability to move or reposition (e,g, spending more of the day in a chair or in bed with minimal movement)
  • Inadequate nutrition
  • Dehydration
  • Incontinent of urine or stool
  • Health conditions, like diabetes or vascular disease that affect blood flow



Causes of Skin Breakdown

Three primary contributing factors for skin breakdown include:



Constant pressure on a part of your body decreases blood flow to the skin.

Pressure ulcers usually occur when continuous pressure on the part of your body cuts of the circulation from small blood vessels in the skin.

If our skin does not get enough nutrients and oxygen for too long, the tissue can die, and pressure ulcers may develop.

Bedsores are more common on skin that covers bony body areas, like the tailbone, hips, ankles, and heels.



Friction can cause skin breakdown, for example, when the skin rubs against bedding or clothing.

A friction injury happens when the top layer of skin (epidermis) separates from the bottom layer of skin (dermis).

It is commonly referred to as ‘rug burn.’  This can make the skin more susceptible to breakdown, especially if the skin is moist.


Skin Shearing

Skin shearing happens when there is both pressure on the skin and friction.

With skin shearing there is pressure downward on the internal layer of skin but also friction that drags the top layer of skin.


Skin shearing usually comes from pulling the upper body up in bed without lifting the lower part of the body.

Another way skin shearing can occur is dragging a leg or arm when transferring.

Additionally, skin shearing can happen when an assistive device rubs up against your body.



What to Look For – Skin Breakdown

  • Watch for skin discoloration. The discoloration may be red, pink, brown, purple, grayish, whitish, or blackish.
  • You may see something that looks like a bruise, blister, pimple, scratch, tear or scrape.
  • Changes in skin texture, tenderness, or skin swelling.
  • Changes in skin temperature, like an area that feels warmer or cooler compared to other areas.


Complications of Skin Breakdown

Pressure ulcers can quickly turn into skin infections (cellulitis).

Signs of a skin infection may include having a fever, drainage from the sore, increased redness, swelling or warmth around the sore, or a sore with a foul odor.

Even worse, a skin infection can get into bones and joints, or cause other health conditions.




caregiver pushing elderly woman in wheelchair

Skin Breakdown Prevention


  • Reposition, or shift your weight about once every hour.
  • If you use a wheelchair, make sure it is the right size for you. Consider sitting on a foam or gel cushion. Shift your weight frequently by learning from one side to the other or leaning forward.
  • Some chairs and wheelchairs allow you to tilt them, repositioning pressure.
  • While in bed:
    • Pillows can be used, for example, between the knees, under your elbows, tailbone, or calves, to help reposition and minimize pressure.
    • Special mattresses or cushions can also help reduce pressure.
    • Keeping your bed elevated 30 degrees or less helps to prevent shearing.


Skin Care

  • Keep the skin clean and dry.
  • When washing, use a soft cloth or sponge, and do not scrub hard.
  • Keep the skin moisturized and consider protectant barrier creams, especially if there is frequent incontinence of urine or stool.
  • Things like buttons, zippers, thick seams, and wrinkles in bedding can irritate the skin.



Check your skin daily for any warning signs of skin breakdown.

If you see signs of skin breakdown, change your body position so there is no more prolonged pressure on that area.

Call your provider if you see early signs of pressure ulcers or if you see any signs of infection.



Some of our blog articles you may be interested in reading:


16 Common Caregiver Duties and Responsibilities


Getting a Medical Second Opinion – Don’t You Deserve Peace of Mind?




When talking about skin breakdown, people frequently use the terms pressure ulcer, bedsore, decubitus, pressure sores, or ulcer. Skin breakdown prevention is important, especially for those prone to pressure sores. Those susceptible to a pressure ulcer include people who use a wheelchair, are incontinent, have decreased sensation, or are bedridden.  Skin breakdown can happen from continued pressure, friction, or skin shearing. Skin breakdown prevention tips include keeping the skin clean and dry, frequent repositioning, and carefully avoiding things like laying on zippers, buttons, and thick seams.

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