ulcers, also commonly known as "bedsores," are skin disorders that tend to occur in bedridden elderly people. Several types of topical drugs are used for treatment, and it is necessary to use them properly according to the state of the pressure ulcer.
I summarized the occurrence of pressure ulcers and the topical agents used for their treatment.
How can pressure ulcers occur?
A pressure ulcer is defined as "a state in which the body is subjected to pressure for a certain period of time, and the blood flow to the soft tissue (subcutaneous fat, muscle, etc.) between the bone and the surface layer of the skin is reduced, resulting in tissue breakdown."
Sitting in a chair for a long time can make your butt hurt. The bone that supports the body hits that part, and pressure is applied. In healthy people, there is enough subcutaneous fat and muscle in the buttocks, so it acts like a cushion and distributes pressure. You can also move the position of the buttocks to change the place of pressure.
However, thin elderly people have less cushioning tissue, and the pressure from the bones is directly transmitted to the skin. Also, if you can't move your body by yourself, you can't change the position where the pressure is applied. This condition can lead to pressure ulcers.
When are pressure ulcers likely to occur?
The causes of pressure ulcers can be roughly divided into three categories: local factors, systemic factors, and social factors. Pressure ulcers can occur on their own, but they are more likely to occur when a variety of factors combine. If there are factors that apply, it is important to eliminate them as much as possible and to observe whether pressure ulcers occur.
Local pressure, bone protrusion, joint contracture, edema, age-related skin changes, friction, incontinence/humidity, local skin diseases
malnutrition, thinness, aging, underlying diseases, Physical paralysis and difficulty in movement
Lack of nursing care, lack of information, and lack of financial resources
To prevent pressure ulcers ~There are things you can do other than changing your position~
First and foremost is to prevent pressure ulcers from forming. For that purpose, we perform body pressure management, nutrition management, and skin management.
Body Pressure Management
Bedridden people are prone to develop pressure ulcers. Pressure ulcers tend to develop over bony prominences, so pressure should not be placed on such areas for long periods of time. The occurrence of pressure ulcers can be prevented by changing the patient's position or using body pressure dispersion bedding.
In addition, rehabilitation aimed at improving contracture is effective in preventing pressure ulcers.
Poor nutritional status leads to decreased subcutaneous fat and muscle mass, and often bony prominence. Adequate energy and protein intake are important for preventing pressure ulcers and promoting healing after they occur. Serum albumin, a type of protein, is one of the indicators of nutritional status, and patients with low serum albumin levels are at high risk of developing pressure ulcers.
In this case, it is important to improve the nutritional status by reviewing the diet and, if necessary, using tube feeding or parenteral nutrition.
The skin of older people is dry and vulnerable to external stimuli. Injuries are prone to pressure ulcers, so moisturizing lotions and skin protectants are usually used to improve the condition of the skin. On the other hand, too much moisture from incontinence is not good for the skin, so diaper management is also important.
If you have a pressure ulcer ~Pressure ulcer medicine~
the above preventive measures, you may still develop a pressure ulcer. In that case, you will be treated, but first, we will explain the process from the formation of the pressure ulcer until it heals.
Staging of pressure ulcers Pressure ulcers are divided into
shallow pressure ulcers in which skin necrosis stops in the superficial layer of the dermis and deep pressure ulcers that extend below the subcutaneous fatty tissue. Shallow pressure ulcers often heal in a short period of time by protecting the wound with a wound dressing, but deep pressure ulcers may take more than a year to heal. As a deep pressure ulcer heals, the color of the surface of the pressure ulcer changes.
Normally, it progresses in the order of "black stage" → "yellow stage" → "red stage" → "white stage".
The "black stage" is tissue turns black and adheres.
The "white stage" is necroticwhen the granulation tissue grows during the process of healing the pressure ulcer.
Topical medicine for pressure ulcers
There are several types of topical drugs used for medicinal , but the effects are explained by roughly dividing them into two types.
・Drugs that are effective in removing necrotic tissue and controlling infection
GEBEN cream 1%
U-PASTA KOWA Ointment
CADEX OINTMENT 0.9%
・Drugs that promote granulation and epithelialization
wound bed preparation “Black stage” and treatment of the “yellow stage”
It is to prepare the environment of the wound surface to promote the healing of the wound. Specifically, it removes necrotic tissue, controls infection, prevents the wound from drying out, and controls excess exudate.
・Drug exudate used
ExcessU-PASTA KOWA Ointment,CADEX OINTMENT 0.9%,Bromelain Ointment
Appropriate to less exudate:GEBEN cream 1%
The "red stage" and "white stage"
wound surface inHow to hold on to the environment. The exudate contains many growth factors that encourage granulation, and the wound surface is closed with a urethane film or the like to create an appropriate state of exudate and maintain a moist environment. Too little or too much exudate is not good, so topical medicine F or wound dressings are used to keep it in a moderate state.
・Drug exudate used
ExcessActosin Ointment,U-PASTA KOWA Ointment
Appropriate to less exudate:Olcenon Ointment