Sores

Sores, also known as ulcers, are open lesions in the skin or mucous membranes that cause tissue loss because they do not heal on their own or heal with great difficulty.

The areas of the body where sores can appear are very diverse. The most common are:

• Mouth sores: the most frequent type. Also called mouth ulcers, they may be located on the tongue (or under the tongue), palate, gums, lips, or corners of the mouth.
• Anal fissures: sores that form in the tissue lining the anal canal, which is the final section of the digestive system.
• Throat sores: superficial wounds located between the soft palate and the beginning of the larynx and esophagus.
• Corneal ulcers: sores that appear on the cornea, the transparent tissue that allows light to enter the eye.
• Genital sores: occur on the vulva, vagina, anus, or penis.
• Peptic ulcers: sores that appear in the inner lining of the stomach or duodenum.
• Esophageal sores: affect the mucosa lining the tube connecting the pharynx to the stomach.
• Skin sores: these skin ulcers can occur on any area, although they are more common on the legs, feet, and other pressure-bearing areas. They may damage only the epidermis or be deeper, reaching the dermis or even the hypodermis.

The prognosis of sores varies according to their location and depth. While some ulcers, such as corneal ulcers, are a medical emergency, others resolve without complications when treated appropriately.

Symptoms

Sores are usually white, red, or yellow and cause redness in the surrounding tissue. However, their characteristics and associated symptoms vary depending on their location.

• Mouth sores: can cause pain when speaking, swallowing, or brushing teeth. They differ depending on where they appear:
  • Tongue: oval or round, white in color. Since the tongue moves constantly for speaking and eating and is in near-constant contact with the teeth or palate, they cause intense pain.
  • Lip: usually large (more than one centimeter in diameter) and whitish in color. They cause stinging and sharp pain, especially when speaking or eating salty or acidic foods.
  • Gum: cause localized burning and pain, as well as difficulty chewing or speaking.
  • Palate: usually have a reddish border and a yellowish or whitish center. They cause pain when speaking, drinking, or eating, especially hot, spicy, or acidic foods.
• Anal fissures: appear as visible cracks and may have a lump in the surrounding skin. They cause pain during bowel movements, which may persist afterward, and bright red blood in stools or on toilet paper.
• Throat sores: yellow or white ulcers with a reddish border. They are often accompanied by irritation, itching, pain (especially when swallowing), and bad breath.
• Corneal ulcers: visually appear as a small white or gray spot. They also cause eye redness, pain, the sensation of having a foreign body in the eye, blurred vision, photophobia, and excessive tearing.
• Genital sores: although their appearance varies depending on the cause, they are usually small blisters containing yellowish or clear fluid. They are often accompanied by burning, pain, or flu-like symptoms (fever, muscle pain, headache, and swollen glands).
• Peptic ulcers: symptoms may resemble indigestion and include abdominal pain, fullness, nausea and vomiting, bloating, and belching.
• Esophageal sores: cause difficulty and pain when swallowing, heartburn, chest pain, and stomach discomfort.
• Skin sores: in most cases, they are round and open, with a slightly raised edge. They are often accompanied by skin discoloration, fluid discharge, itching, and pain.

Causes

The causes of sores vary greatly depending on where they develop:

• Mouth sores:
  • Viral infections, such as cold sores or herpes zoster.
  • Bacterial infections.
  • Fungal infections.
  • Smoking.
  • Physical or chemical irritants.
  • Food allergies.
  • Side effects of chemotherapy or radiotherapy.
  • Chronic stress.
  • Systemic disorders such as autoimmune diseases, infections, nutritional deficiencies, or immune system abnormalities.
• Anal fissures: Persistent diarrhea.
  • Constipation.
  • Hard or large stools.
  • Vaginal childbirth.
  • Anal intercourse.
  • Inflammatory bowel disease (Crohn’s disease or ulcerative colitis).
  • Sexually transmitted infections.
• Throat sores:
  • Herpes virus infection.
  • Hand, foot and mouth disease.
  • HIV and AIDS infection.
  • Lupus.
  • Throat cancer.
  • Side effects of certain medications used to control high blood pressure, non-steroidal anti-inflammatory drugs, or chemotherapy.
• Corneal ulcers:
  • Bacterial, viral, fungal, or parasitic infections.
  • Eye injuries causing abrasions or burns to the cornea.
  • Disorders that prevent the eyelid from closing completely.
  • Blepharitis.
  • Trichiasis.
  • Entropion.
  • Foreign bodies such as metal fragments, dust, or sand.
• Genital sores: Usually caused by sexually transmitted infections (STIs), such as herpes or syphilis, although they may also result from autoimmune diseases, erythematosquamous disorders (psoriasis), or dermatoses.
• Peptic ulcers and esophageal sores:
  • Helicobacter pylori infection.
  • Side effects of medications such as NSAIDs, corticosteroids, or antidepressants.
  • Gastroesophageal reflux disease (GERD).
  • Chemical irritants such as accidental ingestion of corrosive substances or cleaning products.
• Skin sores:
  • Pressure ulcers: commonly known as bedsores, caused by constant pressure on a specific area of the body, usually due to prolonged immobility.
  • Venous ulcers: caused by poor blood circulation in the veins (venous insufficiency), commonly affecting the legs, particularly knees and ankles.
  • Ischemic or arterial ulcers: common on the lower legs and feet; caused by arterial blockage or poor circulation, often due to arteriosclerosis.
  • Neuropathic ulcers: usually related to diabetes and caused by nerve damage, often at pressure points on the feet.
  • Friction blisters or sores: caused by constant rubbing that separates layers of skin and allows fluid to accumulate.

Risk Factors

The risk of developing sores and ulcers increases in the following situations:

• Mouth sores:
  • Adolescence and young adulthood.
  • Female sex.
  • Poorly fitted dental prostheses.
  • Orthodontic appliances.
  • Excessively vigorous tooth brushing.
  • Deficiency of vitamin B, folic acid, or iron.
  • Fatigue.
  • Stress.
  • Consumption of spicy or acidic foods.
  • Celiac disease.
  • Crohn’s disease.
  • Hormonal changes.
• Anal fissures:
  • Infants and middle-aged adults.
  • Excessive pressure on the anus.
  • Crohn’s disease.
• Throat sores
  • Exposure to streptococcus, herpes simplex, coxsackievirus, HIV, or candida.
  • Weakened immune system.
  • Autoimmune diseases causing inflammation of blood vessels.
  • Radiotherapy or chemotherapy.
  • Vitamin or iron deficiency.
  • Gastroesophageal reflux.
  • Smoking.
  • Alcoholism or excessive alcohol intake.
  • Poor oral hygiene.
• Corneal ulcers
  • Improper or prolonged contact lens use.
  • Dry eye.
  • Keratitis.
  • Diabetes.
  • Foreign bodies or scratches.
  • Chemical burns.
• Genital sores
  • High-risk sexual activity.
  • Excessive friction during intercourse.
  • Weakened immune system.
  • Autoimmune diseases.
  • Previous STI history.
• Peptic ulcers and esophageal sores
  • Age over 60.
  • High doses of NSAIDs.
  • Smoking.
  • Excessive alcohol intake.
• Skin sores
  • Reduced mobility.
  • Prolonged immobility.
  • Morbid obesity.
  • Dehydration.
  • Nutritional deficiencies.
  • Arteriosclerosis.
  • Venous insufficiency.
  • Malnutrition.
  • History of blood clots.
  • Pregnancy.
  • Smoking.

Complications

Untreated sores or those that do not respond as expected may cause complications, such as:

• Mouth sores:
  • Recurrent mouth ulcers.
  • Secondary infection if the sore becomes contaminated with bacteria.
  • Permanent scarring.
  • Dehydration and malnutrition if pain prevents proper nutrition.
• Anal fissures:
  • Recurrent appearance of sores.
  • Difficulty healing.
  • Muscle tear.
• Throat sores:
  • Abscesses: accumulation of pus as a consequence of a bacterial infection.
  • Hoarseness or dysphonia.
  • Difficulty breathing.
  • Dehydration or malnutrition.
  • Spread of the infection to the lymph nodes in the neck or the ears.
• Corneal ulcers:
  • Corneal scars that cause blurred vision.
  • Loss of vision.
  • Perforation of the cornea and loss of aqueous humor.
  • Intraocular infection that may lead to loss of the eye.
  • Excessive increase in intraocular pressure that may cause glaucoma.
• Genital sores:
  • Superinfection of the wounds with suppuration and difficulty healing.
  • Greater susceptibility to contracting HIV.
  • Spread to other parts of the body, such as the eyes or mouth.
  • Conditions affecting the nervous system.
  • Transmission of the herpes infection to the newborn during vaginal delivery.
• Peptic ulcers:
  • Bleeding: gradual blood loss can cause anemia. If the loss is abundant, a transfusion may be needed.
  • Stomach or intestinal perforation.
  • Obstruction of the digestive tract.
  • Stomach cancer.
• Esophageal sores:
  • Hemorrhages.
  • Esophageal stenosis (narrowing of the tube that makes it difficult for food to pass).
  • Esophageal perforation.
  • Barrett’s esophagus (the lining of the esophagus changes its characteristics due to the effect of stomach acids and increases the risk of cancer).
• Skin sores:
  • Bone infection.
  • Joint infection.
  • Cellulitis (bacterial infection of the deep layers of the skin).
  • Gangrene, when not enough blood reaches the tissues.
  • Sepsis (spread of the infection through the bloodstream).

Which specialist treats sores?

Sores are treated in the specialties of Stomatology, Dentistry, Gastroenterology, Otorhinolaryngology, Ophthalmology, Gynecology and Obstetrics, Urology or Medical-surgical dermatology and Venereology, depending on their nature.