SKIN ULCERS

Aetiology

• Infections:

- Bacterial e.g TB, Leprosy, syphilis, anthrax

- Fungal e.g histoplasmosis, etc

- Parasitic e.g. leishmaniasis

• Tumours e.g squamous cell ca., Basal cell ca., melanoma, Kaposi's sarcoma

• Vascular e.g ischaemic (arterial), venous, varicose veins, sickle cell disease, diabetes, thromboangitis.

• Trauma

• Tropical ulcers.

Clinical Features

Ulcers are mainly found in the lower limbs but may occur on any part of the body. Examination should be thorough and systematic; the following are, with brief examples, the characteristics to note:

• Site: e.g. 95% of rodent ulcers (BCC) occur on upper part of the face; carcinoma typically to lower lip while syphilitic chancre affects upper lip

• Size: Carcinoma spreads more rapidly than inflammatory ulcer

• Shape: Rodent ulcers are usually circular, straight edges are found in dermatitis

• Edge: Undermined in TB, rolled in basal cell ca. (Rodent); everted in squamous cell ca. (SCC), vertically punched out in syphilis; slopping in venous and traumatic ulcers

• Base: Palpably indulated in SCC

• Floor: As is seen - granulomatous as in TB

• Discharge: Purulent indicates active infection, greenish discharge is seen in pseudomonas infection

• Lymph nodes: Enlarged mainly in malignant tumours

• Pain: Generally malignant and trophic ulcers are painless. Pain is found in TB, and anal ulcers.

Investigations

This will depend on the causative factor:

• Haemogram

• Pus for C/S

• Blood sugar

• VDRL

• Arteriography

• Biopsy for histology

• Mantoux test

• HIV screen

• Relevant X-rays to rule out bone involvement and/or infections.

Management

This will depend on the cause of the ulcer:

• Antibiotics

• Regular cleaning and dressing with antiseptic

• Wound excision/Skin graft

Malignant and varicose ulcers may need amputation and striping of the varicose veins respectively.

Refer

• Wound that has not healed after two weeks of conservative management

• Any malignant ulcers.