Dear Dr. Roach: I am 89 and just learned that I have the first stages of bed sores on my buttocks. My dermatologist said that I should stay off of it as much as possible and apply hydrocortisone cream. I have chronic obstructive pulmonary disease, and I need to sleep sitting up. I wonder if you have any other suggestions to help my pain and discomfort.
A.A.
Bed sores (also called pressure ulcers) are potentially serious problems that require immediate attention. We 鈥渟tage鈥� bed sores into four categories. Hopefully you have stage one, where there is skin redness, usually over a bony prominence such as the sacrum, the hand-shaped bone at the base of the spine. A stage-two bed sore may be a shallow, open ulcer or a blister. At stage three, there is full-thickness loss of the skin, while a stage four has exposed muscle or bone. Sometimes, it is impossible to stage ulcers from their appearance alone.
A stage-one bed sore is really a warning of potential problems to come. They often are treated with a clear film for protection. Hydrocortisone cream is surprising to me, since steroids can thin the skin when used excessively, which you certainly don鈥檛 want to do. The pain should be treated, but you should be taking this as your body's warning that there is a problem.
The key to preventing further injury is to find a way to take pressure off the area. Sleeping sitting up puts all your weight on your lower back, buttocks and thighs, which in turn puts these areas at high risk for pressure ulcers. There are several ways to combat this, including different kinds of mattresses and pads, and even a device that adjusts automatically to pressure.
Changing positions frequently (every two hours or less) is critical if you are not using a special mattress or pad. There are wound-management specialists, both nurses and doctors, with expertise for your situation. I would ask your doctor about finding and consulting with one.
People with COPD are at high risk for poor nutrition, and making sure you are getting adequate protein and calories is critical, as poor nutrition is a big risk for serious bed sores. I strongly recommend a visit with a nutritionist.
Also, perhaps your COPD treatment could be optimized to make it easier to sleep lying down. This means a revisit with your regular doctor or the consultant doctor treating your COPD.
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Dear Dr. Roach: I recently experienced a rash that appeared on my leg, torso, breast and arm. It was diagnosed by my dermatologist as Wells syndrome after a biopsy. I understand that it is a rare disorder, and I would like to know if you have additional information as to its cause. Is it hereditary?
The choice of treatment was clobetasol cream, to be applied for five days only. The rash has disappeared, but it left a shaded area for quite a while. Any help or information you can give me would be greatly appreciated.
Anon.
Wells syndrome, also called eosinophilic cellulitis, is a rare skin condition that looks very like an infection, but the skin is usually cool, not warm, as it is with an infection. It sometimes can appear after bites or stings, or in association with some blood diseases and infections.
Short-term use of a powerful steroid such as clobetasol is an accepted treatment, especially for itching. Most cases of Wells syndrome go away even without treatment.
