ULCERS, SKINMost skin leg ulcers are the result of venous or arterial disease causing vascular insufficiency (leg ulcers), pressure (decubitus ulcers or bedsores), neuropathy (e.g. diabetic foot ulcers) or some combination of these. Ulcerated skin lesions are also seen in collagen-vascular diseases, e.g. rheumatoid arthritis, and other disorders such as inflammatory bowel disease. A chronic leg ulcer associated with venous insufficiency is the type of ulcer most often seen in clinical practice. VENOUS (GRAVITATIONAL) LEG ULCERSFaulty valves in the veins allow pooling of blood, which increases the venous pressure. Fibrin deposits form around the capillaries and oxygen and nutrient supplies are reduced. The area is swollen. Weeping painless (unless infected) ulcers may be triggered by injury, deep vein thrombosis (DVT), hypertension, obesity, prolonged standing or surgery to the leg. Venous ulcers are usually shallow. The surrounding skin is often dry and itchy. Venous ulcers often occur in the gaiter area close to the malleoli and may be accompanied by skin scaling and brown (haemosiderin) pigmentation. See also Wounds and wound care ARTERIAL LEG ULCERSGenerally are associated with atherosclerosis and poor or reduced circulation. More common in individuals presenting with hypertension, CHD, obesity, hyperlipidaemia and smokers. These painful ulcers appear often on feet, heels and toes. A typical punched out appearance of the edges are present. Peripheral pulses may be absent. See also Wounds and wound care NEUROPATHIC LEG ULCERSNeuopathy from whatever cause may lead to ulcer formation on the lower limbs. DIABETIC LEG ULCERSOften deep, may be painless. Infection is common. Risk factors: • peripheral neuropathy • peripheral arterial disease/ischaemia • poor glycaemic control • foot deformities. LEG ULCER REFERRAL INDICATIONSBefore treatment
During treatment
DermNet NZ. Leg ulcer https://dermnetnz.org/topics/leg-ulcer/ NICE CKS. Leg ulcer - venous; updated 2021. https://cks.nice.org.uk/topics/leg-ulcer-venous/
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