Ulcers can occur on any part of your body. The word “ulcer” is the term used when there is a break in the layers of the skin which fails to heal. Ulcers that are formed on the various areas of the body have different causes. Ulcers happen when the broken skin allows the air and bacteria to enter the underlying skin. An open wound with redness and inflammation on its surrounding area or a scab is usually formed. It is most common on the lower legs and/or feet. When the area of the damaged skin is located below the knee on the leg or on the foot and takes longer than six weeks to heal, leg ulcer has occurred.
Venous leg ulcer is the most common type of leg ulcer. Venous leg ulcer accounts for 80-85% of all cases of leg ulcer. This type of leg ulcer occurs when the veins in the legs are damaged by hypertension or persistently high blood pressure. There are other types of leg ulcers. The other two types are arterial leg ulcers and diabetic leg ulcers. Arterial leg ulcers are caused by poor circulation in the arteries and accounts for about 15% of leg ulcers. Diabetic leg ulcers are caused by the high levels of sugar in the blood which is closely associated with diabetes.
There are several symptoms associated with leg ulcers. These symptoms are caused by blood that is not flowing properly through the veins. There is hyperpigmentation around the ulcer wherein the skin around it darkens or gets discolored. Continuous or intermittent leg pain is experienced by the patient. A ‘heavy’ feeling in the affected area can be felt along with swelling, itching, and aching. Atrophie blanche or smooth, small areas of white with tiny red spots is present. The legs may feel rigid due to the hardened skin around the ulcer or lipodermatosclerosis. Another symptom is pitting edema where the ankles are filled with fluid and are swollen. It temporarily holds the imprint of the fingers when pressed.
Years of studies have proven that the common cause of leg ulcers is not the skin. It is due to the poor blood circulation in the legs which affects the blood supply to the skin. Since the causes of leg ulcer are due to poor circulation, it is closely related with disorders that affect the circulation. The disorders include rheumatoid arthritis, hypertension, and diabetes. Secondary bacterial and viral infections, certain skin conditions can worsen leg ulcers. Depressed or lowered immune systems are also associated with leg ulcers.
Diagnosing leg ulcers is based on the way the surrounding skin of the ulcer looks, the location of the ulcer, and the symptoms present. The diagnosis by the healthcare provider is determined through: the comprehensive physical examination by a wound specialist; the patient’s medical history; laboratory tests such as CT scans, MRIs, and X-rays; and noninvasive vascular studies.
Treatment of leg ulcers will depend on the causes of the ulcer and on what is preventing its healing. The treatment may involve cleansing of the wound, anti-inflammatory medication, and application of dressings. Elevation and compression dressings are administered to venous leg ulcers for patients with no arterial diseases. Vascular surgery may also be beneficial for arterial ulcers.
