Bedsores are classified by stages, depending on the extent of skin damage. It’s critical to spot a developing bedsore early, to get the pressure off the affected area right away and to call in medical professionals to advise on and supervise treatment.

Stage 1–First sign of a possible skin sore is a reddened, darkened or discolored area on light skin. Darker skin may look purple, bluish or shiny. The spot may feel hard or warm when touched. There may be pain, or blisters or a bruised appearance. When you press on the area, it stays red and doesn’t return to normal after about 30 minutes. The skin is unbroken.

It’s important to recognize that even though the early signs of skin damage that you see on the surface may look minimal, they are only part of the picture. There may be damage from pressure on blood vessels against the underlying bone, causing damage to the muscles and tissues under the skin.

Stage 2—The top layer of skin (epidermis) is broken; it looks like a shallow open sore. There may be mild swelling, oozing or pus.

Stage 3—The ulcer becomes deeper, extending into the fatty tissue below the skin’s surface. Look for signs of infection—pus, odor, fever, drainage. Wounds at this stage often need specialized wound care.

Stage 4—The wound is deeper, extending into the muscle and May go as far down as the muscle, tendon or bone. There is a high possibility of infection. Surgery is often needed to repair the wound.

Some bedsores are called “unstageable” because the base of the wound is covered by so much dead tissue or scarring so that it’s impossible to tell the extent of the damage until the dead tissue has been removed in a process called “debriding.” Frequently, it reveals a Stage 3 or 4 bedsore.

Suspected Deep Tissue Injury shows no break in the skin, but a lot of bruising or blistering and tenderness at the surface. There is damage due to pressure going on underneath the skin where the bone meets the tissue. Deep tissue injuries often develop into Stage 3 or 4 bedsores.