Kennedy Terminal Ulcer

A Kennedy ulcer is a nonhealing skin sore that may form when you’re dying. The most common site for these ulcers is the skin on your tailbone and on the area above it (sacrum). Also called a Kennedy terminal ulcer (KTU), these sores can be a sign that death is close.

Preventing and caring for wounds is an important part of end-of-life care, or hospice care — especially when a person is too sick to get out of bed. But not all wounds are the same. Most people are familiar with pressure injuries, like bedsores. These form when skin starts to break down after being in contact with other materials (like a mattress) for too long. Caregivers can often prevent and heal bedsores.

But Kennedy ulcers are different because they develop despite good skin care. When someone is dying, it’ common to have organ failure. Skin is an organ and can fail, too.

Symptoms of a Kennedy terminal ulcer

Kennedy ulcers can be easy to mistake for bruises, bedsores or other types of tissue injuries. A Kennedy terminal ulcer:

• May be red, purple, yellow or black (black is often a sign of tissue death)
• Usually appears on your sacrum or tailbone, but it can also show up on your butt, spine, arms, shoulders, legs and heels
• May have a butterfly or pear shape (usually on your butt or sacrum)
• May look like squiggly, parallel lines (usually on your spine, back, shoulder or limbs)

3:30 syndrome

Sometimes, these ulcers get worse fast — in a matter of hours. The quick progression has led some medical experts to name a subtype of Kennedy ulcers the “3:30 syndrome.”

Some of the caregivers who first identified the Kennedy ulcer noticed tiny black spots on patients’ skin in the morning. They described them as looking like specks of dirt or poop. But they were small sores.

When they checked on patients later in the afternoon (around 3:30 PM), the spots had grown to blisters the size of a silver dollar. These patients often died within 24 hours.

Kennedy ulcer causes

Doctors don’t know what causes a KTU. But it’s likely a result of your body shutting down during death.

When we die, our organs stop working. Skin is your body’s largest organ. It provides clues about how the systems inside your body are doing. For example, a dying heart is unable to pump blood throughout your body like it once did. This is called heart failure. Your heart is unable to keep your skin healthy and hydrated. As a result, your skin can die.

External factors (like pressure on your skin) can contribute to skin breaking down. But with Kennedy ulcers, the problem — like heart failure— is skin failure.

How doctors diagnose this condition

Kennedy ulcers usually show up when a person is already dying and receiving hospice care. An important part of hospice is caring for your skin to prevent bedsores. A new wound that appears despite this care, and that doesn’t respond to healing treatments, is likely a terminal ulcer.

How is it treated?

Treatment focuses on easing pain from the Kennedy terminal ulcer. Caregivers may apply gels or foams to the wound to help with discomfort. It may also involve managing any odors from the dying tissue. Caregivers may apply activated charcoal dressings to absorb odors. They may place essential oils in the room (not on the wound).

The goal is to ease your loved one’s transition into death so that they can spend their last days with as much comfort and dignity as possible. A hospice team specializes in this type of care and can be a good resource.

What is the life expectancy of someone with a Kennedy ulcer?

A Kennedy ulcer often means that death is days or weeks away. The timeline can range from as little as 24 hours up to several months.

When a loved one is dying, most of us want to know the specifics. We want to know exactly how much time we have with them. No one can predict this exactly. But your medical team can help guide you.

Is there anything I can do to feel better?

Know that your loved one’s care team is doing everything they can for your loved one. This includes caring for their wound.

It may help to know that identifying a wound as a Kennedy ulcer helps caregivers know that pain management (not healing) is the goal. This can spare your loved one any unnecessary discomfort from healing treatments.

Still, it’s hard to find reassurance when we’re losing someone we love. Allowing yourself the grace to grieve is essential when you start seeing signs that death is near.