Is It a Pressure Sore or Just Redness? 5 Early Warning Signs You Can’t Ignore
For caregivers and individuals with limited mobility, understanding the difference between temporary skin redness and the beginning of a pressure sore is critical. A pressure sore—also known as a pressure ulcer or bedsore—can develop in just a few hours if constant pressure restricts blood flow to a specific area of the body.
The difference between a mild irritation and a serious medical issue often comes down to early detection. If a sore is caught early, it can often be reversed with proper care. If ignored, it can progress to deep tissue damage. Here are five early warning signs that the redness you see is a pressure sore, and exactly what you need to do to protect skin health.
1. The Blanching Test (The Redness Doesn't Turn White)
The most definitive way to test if redness is a pressure sore is to check if it "blanches." This means the spot turns white when you press on it, and then turns red again when you release pressure.
Temporary Redness: The skin blanches quickly. This is normal reactive hyperemia, where blood rushes back into the area after pressure is released.
Pressure Sore Signal: The area stays red (or purple/blue on darker skin tones) even when you press on it. This indicates that the tiny blood vessels have been damaged and are no longer functioning correctly.
2. The Texture Changes (Firm or Boggy)
Gently feel the area of redness. A normal red spot will feel like the surrounding skin. A developing pressure sore will feel different to the touch.
Pressure Sore Signal: The skin feels significantly firmer, harder, or "denser" than the surrounding skin. Conversely, it might feel "boggy" or softer, indicating tissue breakdown underneath the surface.
3. Temperature Differences
Use the back of your hand to check the temperature of the area compared to the surrounding skin.
Pressure Sore Signal: The area feels noticeably warmer than the skin around it, which is a sign of inflammation. Less commonly, the area may feel cooler if blood flow has completely stopped.
4. Sensations of Pain, Itching, or Burning
While some advanced sores may not be painful because nerve endings have died, early-stage sores are often uncomfortable.
Pressure Sore Signal: The individual reports itching, burning, or aching in the specific red area, even if they cannot see it themselves.
5. It Happens Over a "Bony Prominence"
Pressure sores do not happen randomly; they occur where bones are close to the skin, causing the skin to be compressed against a mattress or chair.
Pressure Sore Signal: Any redness located on the tailbone (coccyx), hips, heels, shoulder blades, elbows, or the back of the head must be treated as a potential pressure sore until proven otherwise.
Summary Checklist: When to Take Action
| Warning Sign | What it Means | Immediate Action |
| Redness doesn't blanch | Stage 1 Pressure Sore | Remove all pressure immediately. |
| Tissue feels hard or soft | Tissue breakdown | Change position, check surface quality. |
| Area is hot to touch | Inflammation | Keep clean, monitor closely. |
| Itching or burning | Nerve irritation | Inspect daily, apply barrier cream. |
| Redness on bony spot | High-risk area | Review repositioning schedule. |
What to Do Immediately
If you identify any of these five signs, do not wait for the skin to break.
Remove All Pressure: The most important step is to ensure zero pressure is placed on the red area. If it is on the tailbone, the person must lie on their side.
Reposition Frequently: Do not let the person sit or lie in the same position for more than two hours.
Use Support Surfaces: Ensure they are using a pressure-redistribution mattress or a specialized wheelchair cushion.
Keep the Area Clean and Dry: Moisture from sweat or incontinence makes skin fragile.
By paying attention to these early warning signs, you can prevent a minor spot from turning into a major health issue.
Understanding Pressure Sores: A Comprehensive Guide to Prevention and Care