A 46-year-old female schoolteacher presented with an ulcer in the lower part of the left leg, which had been present continuously for the past year. Skin ulceration had occurred intermittently in the same spot for a period of some 15 years but has always healed after varying intervals with local wound care and dressings. A series of Unna boot applications and other supportive treatment had failed to heal the ulcer this time, and the patient had been for further treatment. According to the patient, the onset of skin ulceration was gradual and there were no elements in her history (e.g. trauma, major surgery or illness) that might have predisposed the development of deep venous thrombosis (DVT). Additional symptoms included pain in the ulcer and the pretibial area, which the patient described as “shooting”. She characterised the pain as 7/10 over a visual analogue scale. Pain was worst in the evening hours after prolonged periods of standing during school hours. The pain subsided gradually with leg elevation, and the patient formed a habit of sleeping with her legs elevated on a pillow. On a particularly stressful day, she found it useful to elevate her leg during breaks at school, although this was seldom possible due to her busy schedule.
KeywordsArthritis Heparin Warfarin Vasculitis Dermatitis
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