Dilemmas about the decubitus ulcer: skin-fold ulcerations and apposition lesions

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Skin lesions are often difficult to diagnose, and even decubitus ulcers (bedsores) can have different manifestations. Two such variations are ‘skin-fold’ ulcerations and those caused by the prolonged apposition of skin surfaces. When pressure is applied to apposed or folded skin, surface ulcers can occur. There is evidence that such lesions are particularly found on debilitated elderly subjects with easily tented skin, as well as on similar patients with chronic contractures. A careful consideration of skin-fold causation helps in preventing ulceration problems, especially where pelvic skin is involved. The effective treatment and/or management of underlying factors, such as pelvic deformities, contractures, dehydration and incontinence, should also help prevent both skin-fold ulcers and apposition lesions.

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