A patient who is close to death may develop skin ulcerations termed SCALE ulcers (Skin Changes at Life's End). The appearance of these lesions is a poor prognostic sign. Their occurrence may be unavoidable.


Synonym: decubitus ominosus (Charcot)


Clinical features:

(1) The patient has a terminal condition.

(2) The patient develops pressure ulcers, ischemic ulcers, mottling or other skin changes.

(3) The skin lesions occur despite adequate skin care.

(4) The patient has multiple risk factors (see below).


Factors contributing to lesions:

(1) malnutrition

(2) decreased perfusion pressure

(3) immobility, typically bedridden

(4) injection site injuries

(5) immune deficiencies


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