The white material on the ulcer is called pseudomembrane, and this condition is mostly seen during the healing process of the ulcer. The pseudomembrane is composed of shed necrotic cells, inflammatory cells, and inflammatory exudate fibrin, and its presence may generally interfere with the growth of granulation tissue. If tolerated by the patient, the pseudomembrane can be removed during the dressing change to allow for better local blood flow. However, removal of the pseudomembrane is often associated with severe pain, so it is usually possible to remove the pseudomembrane under local anesthesia or as soon as the patient can tolerate it to allow for early local healing. If there is a large amount of purulent exudate along with the pseudomembrane, the pseudomembrane should be removed as soon as possible regardless of the situation.