Differential diagnosis and therapy of leg ulcers

Abstract

A leg ulcer is a symptom and the treating physician needs to find out its origin by differential diagnostic approaches and procedures. The correct diagnosis leads to a specific therapy that ideally accelerates the healing of the ulceration. Identifying the pathogenesis of a leg ulcer is the first and main step towards healing. Although vascular diseases are the major causes of leg ulcers, one needs to consider, in addition to venous and arterial disorders, autoimmune, infectious, metabolic and neoplastic causes. The simple truth that one can only make a diagnosis that was considered holds particularly true in leg ulcers. The differential diagnostic considerations presented here appear in the daily routine of a dermatologist and the article provides help in diagnostic approaches and therapeutic decisions.

Therapy‐resistant chronic leg ulcers

“…As more severe clinical courses with a high mortality have been observed in hepatitis B-associated PAN, antiviral therapy is recommended in addition to immunosuppressive treatment [3]. Additional complementary measures of conservative ulcer management (wound debridement, moist wound treatment) also help facilitate healing of skin ulcerations [9,10].…”

Pain and pain management in dermatology

“…Besides the actual wound pain, arterial ulcers, which primarily occur in the context of peripheral artery disease (PAD), are characterized by exertional pain induced by hypoxia [27]. Etiologically, leg ulcers may be caused by a wide variety of disorders, thus requiring a targeted differential diagnostic workup [28]. In addition to pyoderma gangrenosum, which is separately discussed below, the painful hypertensive ulcer should be mentioned in this context.…”

Therapieresistente chronische Ulcera crurum

“…Da bei Hepatitis-B-assoziierter PAN schwerere Krankheitsverläufe mit hoher Mortalität beobachtet werden, wird zusätzlich zur immunsuppressiven Therapie eine antivirale Therapie empfohlen [3]. Ergänzend zur immunsuppressiven Systemtherapie beschleunigen Maßnahmen der konservativen Ulkustherapie (Wunddébridement, feuchte Wundbehandlung) die Abheilung kutaner Ulzerationen [9,10].…”