Diagnosis

The differing presentation of arterial and venous ulcers helps in distinguishing between them, but some degree of aterial insufficiency often complicates venous ulcers.

Phlebography and Doppler ultrasound may help in detecting venous incompetence and arterial obstruction, which can sometimes be treated surgically.

Ulcers on the leg may also occur secondary to other diseases, because of infection, in malignant disease, and after trauma.

Secondary ulcers

Ulcers occur in diabetes, in periarteritis nodosa, and in vasculitis. Pyoderma gangrenosum, a chronic necrotic ulcer with surrounding induration, may occur in association with ulcerative colitis or rheumatoid vasculitis.

Ulcer in diabetic foot

Tuberculous ulceration

Ulcer in diabetic foot

Tuberculous ulceration

Squamous cell carcinoma in venous ulcer

Infections

Infections that cause ulcers include staphylococcal or streptococcal infections, tuberculosis (which is rare in the United Kingdom but may be seen in recent immigrants), and anthrax.

Malignant diseases

Squamous cell carcinoma may present as an ulcer or, rarely, develop in a pre-existing ulcer. Basal cell carcinoma and melanoma may develop into ulcers, as may Kaposi's sarcoma.

Dermatitis artefacta

Trauma

Patients with diabetic or other types of neuropathy are at risk of developing trophic ulcers. Rarely they may be self induced— "dermatitis artefacta".

Further reading

Browse NL, Burnand KG, Lea M. Diseases of the veins: pathology, diagnosis and treatment. London: Edward Arnold, 1988 Kappert A. Diagnosis of peripheral vascular disease. Berne: Hauber, 1971

Ryan TJ. The management of leg ulcers, 2nd ed. Oxford: Oxford University Press, 1987

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