aetiology
Last reviewed 01/2018
Causes include:
- vascular (1)
- venous - ulceration following deep venous thrombosis, varicose veins
- arterial - ischaemia, atherosclerosis, arteriovenous malformation
- mixed
- vasculitis - systemic lupus erythematosis, rheumatoid arthritis, scleroderma, polyarteritis nodosa, Wegener's granulomatosis
- lymphatic
- neuropathic - diabetes, tabes dorsalis, spina bifida, leprosy in endemic areas, peripheral neuropathy (1)
- metabolic - diabetes, gout,
- haematological - haemolytic anaemia, especially sickle cell disease, hereditary spherocytosis, polycythaemia rubra vera
- malignancy - usually squamous cell skin carcinoma. Also Marjolin's ulcer or Bowen's disease
- rheumatoid arthritis - ulceration is multifactorial
- panniculitis - necrobiosis lipoidica - may be diabetic
- gumma
- pyoderma gangrenosum - often associated with ulcerative colitis
- trauma e.g. traumatic flap lacerations over the shin; artefact, burns, cold injury, pressure sore, radiation, factitious (1)
Many leg ulcers have a multifactorial aetiology e.g. arterial ischaemia, venous hypertension, anaemia, infection (2).
Reference:
- (1) Agale SV. Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management. Ulcers 2013;vol. 2013, Article ID 413604, 9 pages
- (2) Simon DA, Dix FP, McCollum CN. Management of venous leg ulcers. BMJ 2004;328:1358-1362