(Dermatology)

Overview

• Localised area of damage and breakdown of skin due to inadequate arterial blood supply
• Usually seen on feet of patients with severe atheromatous narrowing of the arteries supplying the legs
• Risk Factors → coronary heart disease, history of stroke or TIA, diabetes, peripheral arterial disease, obesity, smoking, high cholesterol
• 22% of leg ulcers, prevalence increases with age

Making Diagnosis

Clinical Features:

• Often distal → commonly involves heel (+ lateral malleolus) and tips of toes
• Often causes severe pain (more painful when elevated)
• Punched-out appearance
• Well defined borders
• Night Pain ⇒ hallmark of arterial ulcers. Pain worse when lying down (as arterial blood flow reduced even further. Pain relieved by dangling the affected leg off the end of the bed.
• Signs ⇒ hair loss, shiny, cold and pale skin. Absent pulses.
• Arterial Ulcer
• Location of Different Ulcers