ulcers

Causes of leg ulcers

1 Venous stasis ulcer-most common (Figure 3.31)

Site: around malleoli

Associated pigmentation, stasis eczema

2 Ischaemic ulcer (Figure 3.32)

Large artery disease (atherosclerosis, thromboangiitis obliterans): usually lateral side of leg (pulses absent) Small vessel disease (e.g. leucocytoclastic vasculitis, palpable purpura)

3 Malignant ulcer, e.g. basal cell carcinoma (pearly translucent edge), squamous cell carcinoma (hard everted edge), melanoma, lymphoma, Kaposi's sarcoma

4 Infection, e.g. Staphylococcus aureus, syphilitic gumma, tuberculosis, atypical Mycobacterium, fungal

5 Neuropathic (painless penetrating ulcer on sole of foot: peripheral neuropathy, e.g. diabetes mellitus, tabes, leprosy) (Figure 3.33)

6 Underlying systemic disease

Diabetes mellitus: vascular disease, neuropathy or necrobiosis lipoidica (front of leg) Pyoderma gangrenosum Rheumatoid arthritis Lymphoma Haemolytic anaemia (small ulcers over malleoli), e.g. sickle cell anaemia                  venous ulcer  around malleoli   Associated pigmentation, stasis eczema