What Is Kennedy Terminal Ulcer?

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kennedy ulcer wound careA Kennedy Terminal Ulcer, or Kennedy Ulcer for short, is a type of skin wound or ulcer that is found on some people in the final weeks of their life. The term first came around in 1989. The specific cause of these ulcers largely remains unknown. 

What Causes a Kennedy Terminal Ulcer? 

While some experts blame these ulcers on the fact that the body’s organs are shutting down, others are truly perplexed. For the experts that say these ulcers are a result of organs shutting down, it makes sense. Skin is the body’s largest organ – making up about 10% of the body’s total weight. Skin is also responsible for about a quarter of the blood the human heart pumps each minute. Like any other organ, the skin fails – especially as a person ages. 

Skin can reflect signs and symptoms of illness. For example, illnesses that affect the entire body, called systemic illnesses, will show symptoms on the skin as well. Liver disease is one such illness. With liver disease, a person has swollen blood vessels and reddish palms, also called palmar erythema

So, while the exact cause of a Kennedy terminal ulcer is unknown, it makes sense to some experts. Because it happens in the late stages of death, there are symptoms nurses and doctors look out for. Let’s discuss them below. 

Signs and Symptoms of the Kennedy Terminal Ulcer

  • Ulcer may be red, yellow, or black in color
  • Occurs in the last weeks of a person’s life 
  • Unlike bedsores
  • Onset occurs over a day’s time; for this reason, also called 3:30 Syndrome 
  • Looks like a bruise
  • Surrounding skin may be loose or soft under the surface
  • Occurs in a butterfly or pear shape 
  • Typically occur at the sacrum of the patient (aka the lower end of the spine) 
  • May also appear at tailbone 


kennedy ulcer wound care ocDuring the onset stage, the ulcer develops over a period of a few hours. Just before appearing, the skin may look healthy. In fact, most medical practitioners say that patients look healthy in the morning but by the end of the day they see the effects of the ulcer. Soon, the ulcer begins to appear in the form of spots.  They will grow in number over the next few hours until, around mid-afternoon, those spots become big, black blisters. They grow larger and larger over the next few hours. These black spots are sometimes known as the 3:30 syndrome – because by mid-afternoon the ulcer is undeniable. 

Unlike Bedsores

The Kennedy Terminal Ulcer is unlike other pressure ulcers or bedsores. It’s a phenomenon of its own. Bedsores, for example, take a few days to develop. Also, bed sores have a different cause. They are caused by limited blood flow to the skin, from staying in bed continuously. Bedsores most often happen to people who are bedridden. 

These Ulcers are Unavoidable

A patient at the end of their lives will get this ulcer whether they are taken care of or not. The Kennedy Terminal Ulcer occurs despite the best and most active preventive measures. It occurs whether or not the person is taken care of. These ulcers are unavoidable. 

How is a Kennedy Terminal Ulcer Diagnosed and Treated? 

kennedy ulcer wound care orange countyWhen someone develops a Kennedy Terminal Ulcer, they are likely already being monitored by a healthcare team, whether at a hospital or hospice care unit. Therefore, most healthcare professionals will know what’s occurring. That said, no standard assessment tool exists for determining whether or not something is a Kennedy Terminal Ulcer. A Kennedy Ulcers means the patient is in the final stages of life. They can’t undergo treatment to get rid of them. Instead, treatment for a Kennedy Ulcer focuses on providing the patient with dignity and comfort in the last weeks of life. As these ulcers are often painful, most medical professionals will provide the patient with painkillers to reduce pain. They can also provide pressure-relieving dressings, such as charcoal-infused dressings. 

In Conclusion 

Kennedy Terminal Ulcers occur in the final stages of a patient’s life. While most medical professionals believe these ulcers occur as the result of the organs breaking down, others don’t know the exact cause. These ulcers are unavoidable. They occur even with the best and most diligent preventative care. 

Visit Wound Care OC for all of your Wound Care needs 

Contact Wound Care OC for wound treatment in Orange County, CA

Dr. Faried Banimahd is a board-certified physician specializing in emergency medicine, wound care, and pain management. Our team will work with you to create an individualized treatment plan that meets your needs and unique conditions. Our clinic includes highly trained and experienced physicians, registered nurses, and certified medical staff who work together to provide you with the highest standards of wound care treatments.

To make an appointment

1533 E 4th St,

Santa Ana, CA 92701

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