Cutaneous Arteriolosclerosis Is Not Specific to Ischemic Hypertensive Leg Ulcers

Abstract

Cutaneous arteriolosclerosis is significantly and independently associated with age. Thus, skin biopsy seems not to be necessary for the diagnosis of HLU but only for a differential diagnosis.

Sevoflurano tópico e injertos en sello precoces secuenciales en úlceras arterioloscleróticas en las piernas: una serie de casos

“…Son úlceras localizadas en piernas con pulsos distales palpables, muy dolorosas, con signos de necrosis, de bordes eritemato-violáceos, que pueden progresar rápidamente. Solo se realizará una biopsia para descartar otros diagnósticos diferenciales, como las úlceras por vasculitis o el pioderma gangrenoso, ya que la arteriolosclerosis se puede encontrar en las piernas de cualquier anciano o hipertenso, no es específica de pacientes con heridas (1).…”

“…La biopsia de piel no ayuda a diferenciarlas porque, histopatológicamente, ambos tipos de heridas presentan arteriolosclerosis subcutánea oclusiva. Los resultados de un estudio retrospectivo reciente que compara los hallazgos de biopsias de pierna de pacientes con y sin úlcera de Martorell concluyen que la arteriolosclerosis presente en ambos grupos está asociada con la edad (1).…”

Differentiating Arteriolosclerotic Ulcers of Martorell from Other Types of Leg Ulcers Based on Vascular Histomorphology

“…Consequently, ASUM poses a major risk of underdiagnosis or misdiagnosis, which is particularly disconcerting considering reports of misdiagnosis with other types of leg ulcers, potentially resulting in fatal complications due to immunosuppressive treatment ( 1 , 7 – 10 ). Although several different histological findings in patients with ASUM have been reported, there are no generally accepted, validated histological criteria for ASUM available to date ( 6 , 8 , 16 , 20 , 21 ). The presence of “stenosing arteriolosclerosis”, composed of hyalinosis, muscular hypertrophy, and calcification, has been considered the histological hallmark of ASUM by several authors ( 6 , 13 , 18 , 19 ).…”

“…However, the specificity of these findings has been questioned, and remains a subject of ongoing controversial scientific discussions. Currently, there are no generally accepted and validated histological criteria for ASUM ( 6 , 8 , 16 , 20 , 21 ). In addition, no comparative study of the histomorphology of ASUM vs other types of leg ulcers has been conducted.…”

Ulcus hypertonicum Martorell

“…Eine Arteriolosklerose findet sich bei älteren Personen auch als Zufallsbefund, z. B. in Spindelbiopsien oder Melanom-Nachexzisionspräparaten am Unterschenkel [12].…”