Skin erosion is a shallow wound in which part or all of the epidermis has been lost, but the damage does not extend into the deeper dermis beneath it. Because the basement membrane and deeper tissue stay intact, erosions can heal without scarring, which sets them apart from ulcers and other full-thickness wounds. They show up across a wide range of conditions, from friction blisters that pop open to autoimmune diseases that attack the bonds between skin cells, and their treatment depends almost entirely on what caused them in the first place.
How Erosions Differ from Ulcers
The distinction matters more than it might seem, because the depth of a wound changes how it heals, how much it hurts, and what treatment it needs. An erosion is confined to the epidermis, the thin outermost layer of skin. An ulcer, by contrast, breaks through the epidermis and penetrates into the dermis or even deeper structures like fat and muscle. When healthcare professionals examine a wound, determining whether it is an erosion or an ulcer is one of the first decisions they make, because the two require different care plans and point toward different underlying diagnoses.
Erosions heal primarily through a process called re-epithelialization, in which keratinocytes, the dominant cell type in the epidermis, migrate across the wound bed and multiply to resurface it with new skin.1PubMed Central. Epithelialization in Wound Healing: A Comprehensive Review Because the underlying scaffold of the dermis is still intact, the cells essentially have a blueprint to follow. Ulcers, on the other hand, need to rebuild deeper structural tissue before the surface can close, which is why they take longer to heal and often leave scars. A superficial erosion on healthy skin can close within days, while an ulcer in the same location might take weeks or months.
What Skin Erosions Look Like
Erosions typically appear as shallow, moist, glistening areas where the top layer of skin is missing. They are often pinkish or red because the exposed tissue underneath is well supplied with blood vessels. Unlike a cut, there is usually no clearly defined edge or depth; the wound looks more like the surface has been rubbed or peeled away. They may ooze clear or slightly yellowish fluid but generally do not bleed heavily, since the blood vessels in the deeper dermis have not been breached.
The shape and distribution of erosions offer clinicians clues about the cause. Erosions that follow a linear or geometric pattern often point to something external, like tape removal or friction from medical equipment. Scattered, round erosions on otherwise normal-looking skin may suggest an autoimmune blistering disease, where fragile blisters formed first and then broke open. Erosions in skin folds, around stomas, or in the diaper area usually signal prolonged contact with moisture or irritating body fluids. A single erosion with a honey-colored crust on top is a hallmark of bacterial infection.
Mechanical and Adhesive Causes
One of the most common and most preventable causes of skin erosion is simple mechanical damage. Friction from bed linens, wheelchair cushions, or ill-fitting shoes strips away the epidermis bit by bit, especially in people who cannot reposition themselves. In hospitals and long-term care facilities, a particularly well-documented source of mechanical erosion is the repeated application and removal of medical adhesives like tape, electrodes, and wound dressings.2PubMed. Review of Medical Adhesive Technology in the Context of Medical Adhesive-Related Skin Injury Each time an adhesive is pulled off, it can tear away a thin layer of epidermis, and after several cycles the damage accumulates into a visible erosion. Silicone-based adhesives are gentler than traditional acrylate-based ones, but no adhesive is completely harmless when used repeatedly on fragile skin.
Shearing forces compound the problem. Shearing happens when the surface of the skin is held in place by friction while deeper tissue slides in another direction, like when a person slides down in a hospital bed. The epidermis gets caught between the external surface and the moving tissue below, and eventually it gives way.
Moisture and Chemical Irritation
Prolonged contact with moisture is another major driver of skin erosion, particularly in people dealing with incontinence. When skin sits in contact with urine or feces for extended periods, the combination of wetness, alkaline pH, and digestive enzymes breaks down the skin’s protective barrier. This leads to incontinence-associated dermatitis, a form of irritant contact dermatitis that features pain, redness, softened waterlogged skin, erosion, and scaling, and is frequently complicated by secondary infection.3PubMed Central. Incontinence-Associated Dermatitis in Older Adults: A Critical Review of Risk Factors, Prevention and Management The problem is especially common among older adults in care settings, where the combination of immobility and incontinence creates a perfect storm for skin breakdown.
A related but distinct situation occurs around stomas, the surgically created openings through which bowel or urinary output is diverted. The skin surrounding a stoma is constantly exposed to effluent that contains digestive enzymes and bile acids, which actively digest epidermal tissue. Peristomal skin complications affect more than 40% of ostomy patients and include irritant dermatitis, chronic thickening of the skin, and erosion.4Physiology. Effect of pH and Bile Acids on Protease Activity: Implications for Mitigating Peristomal Skin Complications in Ostomy Patients Several forms of dermatitis can develop around the stoma site, including fecal or urine irritant contact dermatitis, mechanical dermatitis from appliance wear, and allergic contact dermatitis from adhesive components.5Dermatitis®. Stoma Dermatitis: Prevalent but Often Overlooked
Autoimmune Blistering Diseases
Some of the most dramatic erosions are caused by the body’s own immune system attacking the proteins that hold skin cells together. Pemphigus vulgaris is the most widely recognized example. In pemphigus, the immune system produces antibodies against desmogleins, proteins that act like rivets connecting neighboring cells in the epidermis. When those rivets fail, the cells separate from one another and the epidermis essentially falls apart, forming fragile blisters that break open almost immediately and leave behind painful, slow-healing erosions on the skin and mucous membranes.6PubMed. The Multikinase Inhibitor Midostaurin Mitigates Loss of Intercellular Adhesion and Skin Blistering in Pemphigus Vulgaris
The blisters in pemphigus are described clinically as flaccid, meaning they are soft, floppy, and collapse easily rather than staying tense and dome-shaped. They tend to form on normal-looking or slightly reddened skin, and because they are so fragile, patients often present with erosions rather than intact blisters; by the time someone sees a dermatologist, the blisters have already ruptured.7PubMed. Pemphigus Vulgaris: Clinical Aspects and Treatments Pemphigus erosions can be widespread and are frequently found in the mouth, where they make eating and drinking painful. Other autoimmune blistering diseases, such as bullous pemphigoid and epidermolysis bullosa acquisita, produce erosions through slightly different mechanisms but share the general pattern of blisters that rupture and leave denuded skin behind.
Genetic forms of epidermolysis bullosa deserve mention as well. In these inherited conditions, the genes encoding structural proteins at various layers of the skin are defective from birth. Even mild friction or pressure causes the skin to blister and erode, and people with severe forms live with chronic wounds from infancy onward. Management requires a biopsychosocial approach, with nutritional support (often requiring significantly higher protein and calorie intake than average) and careful monitoring for complications like anemia and infection.
Infections That Produce Erosions
Certain infections target the epidermis directly and produce erosions as part of their clinical course. Impetigo, a common bacterial skin infection caused by staphylococci or streptococci, is a textbook example. It typically starts as a small red spot that evolves into a blister or pustule. When that blister pops, it releases fluid that dries into a characteristic honey-colored crust sitting on top of a shallow erosion.8DermNet. Impetigo Impetigo is highly contagious and spreads easily among children through direct contact, but in adults it tends to develop on skin that is already damaged, such as in eczema or around existing wounds.
Herpes simplex virus produces grouped vesicles on a red base that rupture and leave small, round, sometimes painful erosions. Fungal infections in warm, moist skin folds can also erode the surface over time, though they more commonly cause scaling and fissuring before true erosion develops. In immunocompromised patients, infections that would normally stay superficial can become deeper and more destructive, blurring the line between erosion and ulceration.
Why Newborns and Older Adults Are at Greater Risk
Skin erosion is not an equal-opportunity problem. The very young and the very old are considerably more susceptible, and the reasons are remarkably similar at both ends of life. Newborn and elderly skin share a set of structural features that make them less able to withstand mechanical stress: a thinner epidermis, a thinner dermis with a weaker collagen network and less elastin, a flatter junction between the epidermis and dermis with fewer anchoring structures, and a thinner fat layer underneath.9PubMed. Newborn and elderly skin: two fragile skins at higher risk of pressure injury All of these features translate to skin that tears more easily under pressure or shearing forces.
In older adults, the problem is compounded by medications (blood thinners and long-term corticosteroids both thin the skin further), chronic conditions that impair circulation, and immobility. A hospitalized elderly patient on blood thinners who is unable to reposition independently and has adhesive dressings changed daily is facing a convergence of nearly every risk factor for skin erosion simultaneously. In neonatal intensive care units, premature infants face a parallel set of hazards: their skin barrier is underdeveloped, they are surrounded by adhesive monitoring devices, and their skin is constantly exposed to moisture.
Diagnosing the Cause
Identifying what caused an erosion is often more important than describing the erosion itself, because the underlying cause dictates both treatment and prognosis. Clinicians look at several features: the location and distribution of the erosions, their shape and borders, whether the surrounding skin is normal or inflamed, and how quickly the lesions appeared. Erosions that developed gradually in areas exposed to friction or moisture suggest a mechanical or irritant cause. Erosions that appeared suddenly and rapidly worsened, especially in a critically ill patient, raise concern for a more serious process such as severe hypoperfusion from shock or sepsis.10Journal of Tissue Viability. Algorithm for the differential diagnosis between dependence-related skin injuries and severe life-threatening skin injuries
When autoimmune disease is suspected, a skin biopsy can reveal the level at which the epidermis is separating, and direct immunofluorescence testing can detect antibodies deposited in the skin. For erosions that might be infectious, swabs for bacterial culture or viral testing help confirm the organism involved. In some cases, the clinical picture is straightforward: an erosion around a stoma that matches the shape of the appliance flange, or an erosion under an adhesive dressing, does not require much detective work.
Treatment and Wound Care
Because erosions are confined to the epidermis, the primary goal of treatment is to protect the wound bed, keep it moist enough for keratinocytes to migrate across it, and remove whatever caused the damage in the first place. Moist wound healing is a well-established principle: a wound that is allowed to dry out forms a scab that keratinocytes have to burrow under, slowing closure. A wound kept in a moist environment allows those cells to glide across the surface more efficiently.11Advanced Drug Delivery Reviews. Re-epithelialization of adult skin wounds: Cellular mechanisms and therapeutic strategies
Hydrocolloid dressings are among the most commonly used options for superficial wounds. They create a moist, sealed environment over the erosion and have been shown to speed up healing of superficial injuries compared to traditional dry dressings, with the added benefit of reducing wound pain across virtually all wound types.12PubMed Central. Hydrocolloid dressings in the management of acute wounds: a review of the literature Other options include foam dressings, transparent film dressings, and petrolatum-based barrier ointments, chosen based on the wound’s location, size, and how much fluid it is producing.
For erosions caused by specific diseases, treating the wound locally is only half the battle. Pemphigus erosions will not heal durably unless the autoimmune attack on the skin is brought under control, which typically requires systemic immunosuppressive therapy. Erosions caused by impetigo need topical or oral antibiotics. Incontinence-associated erosions will recur unless the moisture exposure is managed through better continence care, barrier creams, and more frequent skin cleansing with gentle pH-balanced products. Peristomal erosions improve with better-fitting appliances, skin protectants, and sometimes changes to the ostomy output’s consistency through dietary or medical management.
Pain and Its Effect on Healing
Erosions hurt. The exposed nerve endings in the superficial dermis are unprotected, and contact with air, clothing, wound care products, or body fluids can be intensely painful. Pain from wounds is frequently overlooked in clinical settings, yet unresolved pain can actually slow healing by keeping the body in a stress state that diverts resources away from tissue repair.13PubMed Central. Pain management and wound care In people with chronic erosive conditions like pemphigus or epidermolysis bullosa, pain management is not a luxury; it is a core component of wound care.
Dressing changes are often the most painful part of living with erosions. Choosing non-adherent dressings, soaking off old dressings with saline rather than pulling them off dry, and timing pain medication so it peaks during dressing changes all make a meaningful difference. For widespread painful erosions, especially those in the mouth or genital area, topical anesthetics and sometimes systemic pain medication are part of the treatment plan.
The Psychological Toll
Visible skin conditions, including those marked by erosions, carry a psychological burden that extends well beyond the physical wound. Population-level research has found that people with skin diseases report higher levels of depressive symptoms and loneliness, along with lower health-related quality of life, compared to people without skin disease.14PubMed Central. Psychosocial impact of skin diseases: A population-based study For someone with pemphigus erosions on the face, or incontinence-associated erosions that cause constant discomfort, the impact on social participation, self-image, and mental health can be significant.
This psychological dimension is part of why comprehensive wound care programs increasingly incorporate mental health screening and psychosocial support. A wound on the skin is never just a wound on the skin when it affects how someone eats, sleeps, dresses, or interacts with other people.
Preventing Erosions in Clinical Settings
Prevention strategies in hospitals and care facilities target the known risk factors directly. For adhesive-related injuries, that means using silicone-based tapes, rotating electrode sites, applying skin protectant wipes before placing adhesives, and minimizing unnecessary tape use. For moisture-related erosions, structured skin care regimens that include regular cleansing with no-rinse products, application of barrier creams, and prompt changing of incontinence products form the standard of care. For patients at risk of friction and shear injuries, repositioning schedules, pressure-redistributing surfaces, and proper transfer techniques reduce the mechanical load on the skin.
In the specific case of neonatal intensive care, some units have moved to hydrogel-based adhesives and minimal-tape securing methods for endotracheal tubes and monitoring leads, recognizing that premature skin simply cannot tolerate the repeated stripping that standard adhesives produce. For ostomy patients, proper fitting of the appliance at the outset, education on skin assessment, and access to specialized ostomy nursing care are the front line of prevention. Erosions around stomas are common enough that dedicated peristomal skin assessment tools have been developed to catch early signs before the damage becomes extensive.
When an Erosion Signals Something Deeper
Most erosions are minor and heal without incident. But a wound that looks like a simple erosion can sometimes be the surface manifestation of a more serious process. Rapidly expanding erosions in a critically ill patient may indicate skin failure from systemic hypoperfusion, where the body’s blood flow has been redirected away from the skin toward vital organs during shock or sepsis. In that scenario, the skin breaks down not because of any external insult but because it is being starved of oxygen and nutrients from within. These lesions tend to appear suddenly and worsen quickly, and they require management of the underlying critical illness rather than just local wound care.
Erosions that do not heal within an expected timeframe also warrant a closer look. A persistent, non-healing erosion could represent an early skin cancer, a deeper ulcer that was initially misclassified, or an undiagnosed autoimmune or inflammatory condition. Any erosion that has been present for more than two to three weeks without signs of improvement, or that keeps recurring in the same spot, is worth bringing to a clinician’s attention for biopsy or further workup.