Definition

Diabetic ulcers are deep ulcers or wounds on the skin surface in patients with diabetes mellitus. They are usually preceded by an abscess, a painful collection of pus usually caused by a bacterial infection.

Diabetic ulcers often appear on the lower limbs and are the most frequent complication in patients with diabetes mellitus. Uncontrolled blood sugar can cause abscesses, which can progress to ulcers if not treated properly.

All patients with diabetes mellitus can develop abscesses and ulcers, but diabetic ulcers can be prevented by treating abscess wounds properly. The management of diabetic foot abscesses and ulcers varies depending on the cause.

Causes

Abscesses and ulcers in diabetic patients are most often caused by poor blood flow in the foot area, high sugar levels (hyperglycemia), nerve damage in the foot area, or injured or irritated feet.

Poor blood flow in the feet is a type of vascular disease in which blood does not flow properly. Poor circulation can make abscesses take longer to heal, resulting in diabetic ulcers.

High sugar levels can slow the healing process of infections in wound areas. Therefore, blood sugar control plays an important role in preventing diabetic ulcers. This also serves as a reminder that patients with diabetes mellitus always have difficulties in fighting infections originating from their diabetic abscesses or ulcers.

Nerve damage can occur due to the long-term effects of uncontrolled blood sugar. Nerve damage can cause diabetic patients to lose the sensation of pain (numbness), so if a wound, such as an abscess, is present, it may go undetected. Untreated abscesses can lead to diabetic ulcers.

Risk factor

Recognition of several risk factors plays an important role in preventing and treating diabetic abscesses and ulcers.

All patients with diabetes mellitus are at risk of developing diabetic abscesses and ulcers. However, some factors make you more at risk, such as:

• Not wearing footwear when walking or using improper footwear
• Not washing your feet thoroughly
• Not drying the feet after getting them wet
• Cutting fingernails too short
• Having an insect bite wound that is scratched
• Alcohol consumption
• Having visual impairment that makes you prone to foot injuries 
• Obesity
• Smoking

Symptoms

One of the signs and symptoms of abscesses and diabetic ulcers is the flow of pus from the wound, which contaminates socks or footwear. Irritation, swelling, and redness with odor can all be symptoms of an abscess or an early sign of a diabetic ulcer.

The most obvious sign of severe diabetic ulcers is the presence of black tissue surrounding the wound. This occurs due to impaired blood flow. Gangrene or dead tissue due to infection may also appear alongside pain, numbness, and smelly pus.

Diagnosis

Diabetic abscesses and ulcers are clinical diagnoses, meaning doctors can make the diagnosis based on specialized medical interviews and physical examinations. Diabetic abscesses and ulcers are typically distinguished by the appearance of an ulcer or wound deeply indented in the foot area and occurs in patients with diabetes mellitus. Doctors can distinguish between abscesses and ulcers based on the shape of the wound.

However, some additional tests can help a doctor determine the exact diagnosis and any potential complications.  Additional tests, such as blood sugar tests, are often required to determine the underlying cause of abscesses and ulcers. If the blood sugar levels rise, the doctor may conclude that the abscesses and ulcers are caused by diabetes.

Management

Diabetic abscesses and ulcers require comprehensive treatment. It begins with communication, information, and patient education about diabetes and diabetic ulcer complications. Education also includes foot care and blood sugar control, which can be achieved through the use of diabetes medications and patient compliance with these medications. Your doctor will select diabetes medications based on the condition of your diabetes when you visit the nearest health facility.

In addition, wheelchairs, canes, and wound dressings can be used on the wound area to prevent the wound from getting worse or new wounds from appearing.

Your doctor may consider using blood-thinning medications to improve peripheral vascular flow and hopefully allow the abscess or ulcer to heal more easily. However, surgery may also be an option to improve blood flow in certain cases.

Antibiotic administration and infection control are also used to treat abscess wounds and diabetic ulcers. Wound dressings containing collagen and hyaluronic acid are another option that is expected to aid in wound healing.

Complications

Untreated diabetic abscesses can lead to ulcers. In addition, ulcers that do not receive proper care and treatment can lead to several complications such as:

• Cellulitis (inflammation of the skin characterized by noticeable redness)
• Gangrene (death of skin tissue appearing black in color)
• Sepsis (spread of infectious agents throughout the body due to infection of the local ulcer wound)
• Lymphangitis (inflammation of the lymph nodes surrounding the ulcer)
• Osteomyelitis (inflammation of the bone tissue near the ulcer wound)
• Limb ischemia (death of certain organ tissues due to an ulcer resulting in impaired blood flow)
• Amputation (removal of organ tissue from its proper place)

Prevention

Diabetic abscesses and ulcers can be prevented by controlling the risk factors. Preventive measures you can take include:

• Wearing well-fitting and good-quality footwear
• Cleaning your feet after activities and drying them if they are wet
• Cutting toenails appropriately
• Not consuming alcohol
• Seeing a doctor if there is visual impairment due to diabetes
• Consume balanced nutritional food
• Not smoking

If these things are done properly and appropriately, the risk of abscesses and diabetic ulcers in the future can be reduced, and even avoided by people with diabetes mellitus.

When to see a doctor?

If the ulcer appears reddish, hot, or swollen in the area around the wound; there is pus oozing, odor, fever, or chills, and the pain worsens, you should see a doctor. The doctor will conduct a medical interview, physical examination, and additional tests to determine the exact diagnosis and appropriate treatment. Early intervention can reduce the likelihood of complications.

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