Differential Diagnosis for Erythematous Lesions at Pressure Areas in Bedridden Patients

• Single Most Likely Diagnosis
  • Pressure Ulcer (Decubitus Ulcer): This is the most likely diagnosis due to the patient being bedridden, which increases the risk of skin breakdown and pressure sores, especially over bony prominences.
• Other Likely Diagnoses
  • Friction Dermatitis: Caused by repeated friction or rubbing against the skin, which can occur in bedridden patients due to improper positioning or movement.
  • Moisture-Associated Skin Damage: Prolonged exposure to moisture (e.g., from incontinence) can lead to skin irritation and erythematous lesions.
  • Allergic Contact Dermatitis: Reaction to materials in contact with the skin, such as certain components of mattresses or bedding.
• Do Not Miss Diagnoses
  • Infection (Cellulitis or Abscess): While less common initially, any break in the skin can lead to infection, which can spread rapidly in immunocompromised patients.
  • Deep Vein Thrombosis (DVT) with Skin Erythema: Though DVT typically presents with swelling and warmth, erythema can be a sign, especially if the patient is at high risk.
• Rare Diagnoses
  • Vasculitis: Inflammation of the blood vessels can cause skin lesions, though it's less common in the context of pressure areas.
  • Pyoderma Gangrenosum: A rare skin condition that can cause painful ulcers, though it's not typically associated with pressure areas alone.
  • Erythema Ab Igne: Caused by prolonged exposure to heat, which can happen in bedridden patients using heating pads or warm compresses improperly.

Each of these diagnoses requires careful consideration of the patient's history, physical examination, and possibly additional diagnostic tests to determine the underlying cause of the erythematous lesions.