Ulcers - Leg

Key Points
Ulcers appearing on the legs and/or foot
Typically caused by underlying conditions, usually circulatory diseases
Presents in one of two types, venous and arterial
Consists of the loss of skin or tissue in the affected area, and may be accompanied by pain, itching, and skin discoloration

Leg ulcers are any loss of skin or tissue which occurs on the legs and/or feet. The condition typically presents in one of two types, venous and arterial ulcers. Venous ulcers typically form below the knee, usually on the inner ankle. These ulcers may be accompanied by aching legs, brown or black mottled discoloration of surrounding skin, or dryness, redness and itching. Additionally, swelling caused by chronic inflammation may lead to lymphoedema. The condition may also be accompanied by thickening skin, scaling, fissuring, oozing, and papillomatosis.

Arterial ulcers are very painful ulcers which typically form on the feet, toes, or heels. They are accompanied by severe pain, and borders of the lesions have a perforated appearance. Additionally, affected persons may have cold feet which are white or blue in color and cramping in the affected area. Ulcers of both types are vulnerable to secondary infection, which may be accompanied by cellulitis, yellow crusting and a bad odor coming from the ulcer.

Leg ulcers form for a variety of reasons, typically an underlying condition. Venous ulcers have been attributed to varicose veins, a history of chronic swelling or clots, high blood pressure, multiple pregnancies, previous surgery or injury, and obesity. Arterial ulcers are commonly related to diabetes, smoking, high blood pressure/fat/cholesterol, renal failure, obesity, rheumatoid arthritis, clotting and circulatory disease, and a history of heart and/or vascular disease.

Differential Diagnosis (Other conditions with similar appearance)
Basal cell carcinoma
Generalized Essential Telangiectasia
Cellulitis
Klippel-Trenaunay-Weber Syndrome
Contact Dermatitis, Allergic
Squamous Cell Carcinoma
Dermatologic Manifestations of Cardiac Disease
Stasis Dermatitis
Dermatologic Manifestations of Renal Disease
Traumatic Ulcers
Erysipelas
Varicose Veins and Spider Veins

Diagnosis
Key Points
Diagnosis based on skin appearance in conjunction with examination of patient history
Skin biopsy and other testing may be performed to rule out other conditions and determine if secondary infection is present

Ulcers are generally diagnosed based on the appearance of the skin in the affected area, in conjunction with a previous diagnosis of diabetes. Biopsy and other laboratory testing may be performed to rule out other conditions and determine if a secondary infection is present.

Treatment
Goal of treatment is to control symptoms and prevent further infection
Treatment generally consists of debridement of the area and the controlling of any infection present

Leg ulcers can be a serious condition which may have severe complications. Treatment will often consist of establishing the underlying cause of the ulcer and treating that condition. Proper wound care is imperative, including keeping the area clean, properly dressed, and avoiding further injury. Treatment of ulcers generally consists of debridement, the cutting away of dead tissue, exposing healthy tissue to promote healing. Additionally, treatment may consist of Antibiotics to treat any secondary infection.

Venous leg ulcers which are not associated with arterial disorders can usually be treated with elevation, compression therapy and exercise. Sclerotherapy and endovascular laser therapies may also be helpful in treatment. In some cases, when ulcers do not respond to typical treatments, it may be surgically excised or treated with skin grafting. Additionally, use of therapies which accelerate wound healing may be helpful in some cases, though the extent of their effectiveness is not known.