Dermatology - Ulcers

Question 1

What is the history of a venous ulcer? Name some common sites

Answer 1

• Often painful, worse on standing
• History of venous disease: eg varicoase veins, DVT

Sites
-Malleolar area (more common over medial than lateral malleolus)

Question 2

What is the history of an arterial ulcer? Name some common sites

Answer 2

• Painful especially at night, worse when legs are elevated
• History of arterial disease: eg atherosclerosis

Areas
-Pressure and trauma sites: eg pretibila, supramalleolar (usually lateral) and distal points (eg toes)

Question 3

What is the history of a neuropathic ulcer? Name some common sites

Answer 3

• Often painless
• Abnormal sensation
• History of DM or neurological disease

Sies
-Pressure sites: soles, heels, toes, metatarsal heads

Question 4

Describe the lesion and associated features of venous ulcers

Answer 4

Lesion

• Large, shallow irregular ulcer
• Exudative and granulating base

Associated features

• Warm skin
• Normal peripheral pulses
• Leg oedema, haemosidarin and melanin deposition (brown pigment), lipodermatosclerosis and atrophie blanche (white scarring with dilated capillaries)

Question 5

Describe the lesion and associated features of arterial ulcers

Answer 5

Lesion

• Small, sharply defined deep ulcer
• Necrotic base

Associated features

• Cold skin
• Weak/absent peripehral pulses
• Shiny pale skin
• Loss of hair

Question 6

Describe the lesion and associated features of neuropathic ulcers

Answer 6

Lesion

• Variable size and depth
• Granulating base
• May be surrounded by or underneath and hyperkeratotic lesion (callus)

Associated features

• Warm skin
• Peripherla pulses may be normal or basent
• Associated peripheral neuropathy

Question 7

Name some investigations and management for a venous ulcer

Answer 7

Investigations

• Normal ABPI: 0.8-1
• Compression bandaging after exclusion of arterial insufficiency

Question 8

Name some investigations and management for a arterial ulcer

Answer 8

Investigations: ABPI <0.8 is a sign of arterial insufficiency
-Dopple studies and angiography

Management

• Vascular reconstruction
• Compression bandaging is contraindicated

Question 9

Name some investigations and management for a neuropatic ulcer

Answer 9

Investigations:

• ABPI <0.8 implies neuroischaemic ulcer
• Xray to exclude osteomyelitis

Management

• Wound debridement
• Regular positioning
• Appropriate footwear and good nutrition