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Leg ulcerL97.x0
Synonym(s)
leg ulcer; Leg Ulcer; Lower leg ulcer
DefinitionThis section has been translated automatically.
Polyetiological skin defect (symptom) on the lower leg, which extends into the dermis or subcutis. At least the collagenous network of the reticular dermis is affected, but usually also deeper layers of the skin and subcutis. In complicated ulcers, the defect can also reach muscles, fascia and bony areas.
ClassificationThis section has been translated automatically.
Classification of venous leg ulcer by etiology:
- Vascular diseases:
- Venous (see also venous diseases):
- Arterial:
- Vasculitis (or chronic inflammatory vasculopathies):
- Lymphatic (lymphedema)
- Neuropathic disorders (see also neuropathic ulcer):
- Metabolic disorders:
- Diabetes mellitus
- Gout
- Prolidase deficiency
- Gaucher's disease.
- Hematologic disorders:
- Coagulopathies:
- Phospholipid antibody syndrome
- Hereditary thrombophilias (e.g. AT III deficiency, protein C deficiency, protein S deficiency, factor II mutation, lupus anticoagulant)
- Immune thrombocytopenia (Werlhof disease)
- Consumptive coagulopathy
- Purpura fulminans.
- Erythrocyte disorders (e.g. sickle cell anemia, thalassemia, polycythemia vera)
- Leukocyte disorders ( leukemia)
- Dysproteinemias ( cryoglobulinemia, plasmocytoma).
- Coagulopathies:
- Drug-induced:
- Hydroxyurea
- Anagrelide (imidazoquinazoline; for essential thrombocythemia).
- Marcumar
- Nifedipine.
- Traumatic, caused, for example, by:
- Neoplasms:
- Infections (ulcus cruris infectiosum):
- Bacterial: Boils, ecthyma, tuberculosis, syphilis, anthrax, diphtheria, tularemia, leprosy.
- Mycoses: Subcutaneous Trichophyton-rubrum abscesses.
- Protozoa: Leishmaniasis
- Others: Filariasis
- Other causes
- Granulomatoses.
LocalizationThis section has been translated automatically.
Depending on the etiology, there are preferred ulcer localizations.
DiagnosisThis section has been translated automatically.
Medical history, clinic, ultrasound Doppler examination, duplex sonography, light reflection rheography, arterial Doppler, laboratory parameters (blood sugar, factor XIII, zinc level), histology, X-ray image, phlebography, lymphography, arteriography.
Complication(s)This section has been translated automatically.
- Type IV sensitization to local therapeutic agents (especially to wool wax alcohols), risk of osteomyelitis in case of deep-reaching defects.
- Marjolin ulcer: If a chronic leg ulcer persists for years, a malignant transformation cannot be excluded (Marjolin ulcer). In this case, squamous cell carcinomas with a poor prognosis develop, more rarely basal cell carcinomas.
TherapyThis section has been translated automatically.
See the respective clinical picture listed under Etiology.
TablesThis section has been translated automatically.
Etiology |
Diseases |
Frequency in inpatients (%)* |
Frequency in non-selected patients (%) |
Exclusively venous genesis |
e.g. with CVI |
17 |
70-80 |
Exclusively arterial genesis |
e.g. with pAVK |
1 |
4 |
Mixed venous-arterial |
|
|
9,5 |
Other causes |
|
|
9,5 |
| |||
Polyätiological |
2-fold or 3-fold combinations of different causes (in total) |
> 80 |
|
Venous and arterial genesis + vasculitis |
17 |
||
Venous and arterial genesis + polyneuropathy |
8 |
||
Other combination ulcers (bacterial infections, Pyoderma gangraenosum, artifacts, traumas of any kind) |
> 50 |
||
Note(s)This section has been translated automatically.
Remember: A leg ulcer is not a diagnosis but only a symptom!
LiteratureThis section has been translated automatically.
- Combemale P et al (2007) Malignant transformation of leg ulcers: a retrospective study of 85 cases. JEADV 21: 935-941
- King B (2004) Is this leg ulcer venous? Unusual aetiologies of lower leg ulcers. J Wound Care 13: 394-396
- Moffatt CJ, Frank's PJ (2004) Implementation of a leg ulcer strategy. Br J Dermatol 151: 857-867
- Mayer W, Jochmann W, Partsch H (1994) Varicose ulcer: healing in conservative therapy. A prospective study. Vienna Med Weekly 144: 250-252
- Rappoport L et al (2008) Occurrence of ulcer crurum in connection with the intake of Anagrelid. Act Dermatol 34: 132-134
- Stücker M et al. (2003) On the pathogenesis of therapy-resistant leg ulcers. Dermatologist 54: 750-755
- Trummer M et al (2002) Clinical relevance of + patch test reactions to lanolin alcohol. Contact Dermatitis 46: 118