Signs and Symptoms/Clinical Presentation
The initial sign of PrUs is erythema. In dark skin erythema appears darker, with possible red, blue, or purple hues. Pressing on
the skin in erythematous areas may result in prolonged blanching (i.e., loss of color), which indicates ischemia. Nonblanching
erythema is considered a stage I PrU. Sites that tend to develop PrUs from friction are the spine, hips, elbows, and heels. Other
manifestations include localized skin breakdown and underlying tissue damage. Deeper damage to the dermis and underlying
structures may have an intact overlying epidermis. Stage III and IV PrUs extend deeper than the skin and are the ulcers most
likely to require surgical debridement.