At stage III, the skin develops an open, sunken hole called a crater or ulcer. The tissue below the skin is damaged. You may be able to see body fat in the ulcer.
Seeing body fat is the detail that sets it apart, and it’s the kind of thing people find alarming to look at and hard to describe. It means the damage has gone below the skin into the layer underneath, but not yet to muscle or bone.
The practical result is a change in who manages it. Stage I or II sores will often heal if cared for carefully. Stage III and IV sores are harder to treat and may take a long time to heal, and most stage III and IV sores will be treated by your provider. Ask about any special instructions for home care.
That’s different from the earlier stages, where cleaning and dressing instructions are given to the patient or caregiver directly. At stage III, the treatment isn’t a home routine.
What doesn’t change is everything around the wound. Pressure relief: pillows, foam cushions, booties or mattress pads chosen with a provider, repositioning about every 2 hours in bed and every 15 minutes in a wheelchair, and no donut-shaped or ring-shaped cushions. Friction: avoid slipping or sliding when moving, and avoid positions that put pressure on the sore. And do not massage the skin near or on the ulcer, because it can cause more damage.
Nutrition matters too. Eating healthy foods and getting the right nutrition will help you heal, along with avoiding smoking, losing excess weight and getting plenty of sleep.