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Author: A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, February 2016.
A chronic leg ulcer is defined as full thickness skin loss for > 3 months. At times, it can be difficult to determine the correct diagnosis of a leg ulcer. At least 15% of leg ulcers are of mixed aetiology. It is essential to take a thorough medical history and to examine the patient carefully, looking for local and systemic clues to the diagnosis.
Whatever the primary cause of the ulcer, there are often other factors that contribute to the poor healing of ulcers. These include:
An ulcer often begins with:
Chronic infection can also be responsible for ulceration, particularly:
Infections causing leg ulcers
Ulceration due to venous insufficiency
Diabetic ulceration (mixed aetiology)
Ulcerated skin cancers
Inflammatory causes of leg ulceration can be difficult to diagnose and difficult to treat.
If considering an inflammatory cause of leg ulceration, diagnostic tests may involve:
Small vessel vasculitis
Medium vessel vasculitis: polyarteritis nodosa
Ulcerated necrobiosis lipoidica
Ulcerated systemic sclerosis
Levamisole-adulterated cocaine can result in a combination of:
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