Leg ulcers Flashcards
Features of venous ulcers
Gaiter region
sloping edges, Shallow
Granulating base
Warm skin
Worse on standing
Associated features of venous ulcers
Varicose veins/DVT HX
Haemosiderin deposition
Venous eczema
Lipdermatosclerosis
Atrophie blanche - excruciatingly painful, stabbing, white due to ischaemia
Features of arterial ulcers
Distal, smooth hairless skin; gangrene
Punched-out, well-defined appearance, deep
Cold skin
PAD risk factors, Hx (e.g. intermittent claudication)
ABPI <0.8, prolonged CRT, absent pulses
More painful when elevated, worse in bed
Management of leg ulcers
Skin care incl. infection risk
Smoking, risk factor control
Anaemia, malnutrition, hyperglycaemia
Angioplasty if arterial, compression if venous
Topical steroids if overly exudative
Features of neuropathic ulcer
Often on distal pressure point
Associated neuropathy (e.g. diabetes) - painless!
Surrounding callus, punched out
Podiatry, footwear, self-monitoring review - avoid trauma
Wound debridement, X-ray for ?osteomyelitis
Meds delaying ulcer healing
nicorandil
Amlodipine
Hydroxyurea
Features of pyoderma gangrenosum
Tender blister/pustule/papule –> breakdown into necrotic ulcer
Violaceous border, ragged
Purulent base
Rapid progression
Management of pyoderma gangrenosum
Oral corticosteroids
Topical tacrolimus
Features of vasculitic ulcers
Palpable raised purpura around edges
Painful, punched out ulcers
Associations of pyoderma gangrenosum
IBD
RA, other rheum
Haem malignancy
Autoinflammatory disease
Causes of vasculitic ulcers
Drugs - esp abx
Infx - strep, hep B, hep C
CTD - RA, SLE
Malignancy - esp lymphoproliferative
ANCA-assoc vasculitides
Management of vasculitic ulcers
Urine dipstick for glomerulonephritis
Remove ppt cause
COmpression bandage + elevate for venous stasis
Oral steroids for severe/systemic vasculitis
Causes of vasculopathic ulcers
Sickle cell
Thrombocythaemia
Cryoglobulinaemia
Calciphylaxis
Features of calciphylaxis
Web-like pattern of mottling - livedo reticularis
indurated plaques –> Ulceration + necrotic centre
Very painful
Assoc w/ CKD and Ca/PO4 abnormalities, or hyperPTH
Also diabetes, obesity, steroids, warfarin, autoimmune disease, malignancy
Management of calciphylaxis
Supportive
Avoid trauma/compression
Analgesia
Correct Ca/PO4 levels, parathyroidectomy
Features of necrobiosis lipoidica
Yellow-brown plaques
Normally on shins
Atrophic skin - telangiectasia
Assoc w/ diabetes
Painful
