Atypical Leg Ulceration

  • Ajay K. Khanna
  • Divya Khanna


Skin ulceration of the lower extremity poses a difficult clinical problem. Chronic ulceration of the lower legs is a relatively common condition among adults, one that causes pain and social distress and results in considerable healthcare and personal costs. Since numerous factors lead to lower leg ulceration, it is essential that health professionals adopt an interdisciplinary approach to the systematic assessment of the individual in order to ascertain the pathogenesis, a definitive diagnosis, and optimal treatment required. A correct diagnosis is essential to avoid inappropriate treatment that may delay wound healing, cause deterioration of the wound, or harm the patient [1]. Though a majority of the ulcers are venous, arterial, or diabetic ulceration, there are many unusual causes of the ulcers of the lower extremity. It has been reported that ulcers related to venous insufficiency constitute 70 %, arterial disease 10 %, and ulcers of mixed etiology 15 % of leg ulcer presentations. The remaining 5 % of leg ulcers result from less common pathophysiological causes, and this latter group comprise considerable challenges in diagnosis, assessment, and management.


Sickle Cell Anemia Thrombotic Thrombocytopenic Purpura Necrotizing Fasciitis Essential Thrombocythemia Pyoderma Gangrenosum 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Rayner R, Carville K, Keaton J, Prentice J, Santamaria N. Leg ulcers: atypical presentations and associated comorbidities. Wound Pract Res. 2009;17(4):168–85.Google Scholar
  2. 2.
    Mekkes JR, Loots MAM, Van Der Wal AC, Bos JD. Causes, investigation and treatment of leg ulceration. Br J Dermatol. 2003;148:388–401.CrossRefPubMedGoogle Scholar
  3. 3.
    Reilly A, Snyder B. Raynaud phenomenon. Am J Nurs. 2005;105(8):56–65.CrossRefPubMedGoogle Scholar
  4. 4.
    Wilson H, Vincent R. Autoimmune connective tissue disease: scleroderma. Br J Nurs. 2006;15(15):805–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Graves JW, Morris JC, Sheps SG. Martorell’s hypertensive leg ulcer: case report and concise review of the literature. J Hum Hypertens. 2001;15(4):279–83.CrossRefPubMedGoogle Scholar
  6. 6.
    Kluger N, Koijonen V, Senet P. Martorell ulcer. Duodecim. 2013;129(10):1031–6.PubMedGoogle Scholar
  7. 7.
    Grzeszkiewicz TM, Giorentino DF. Update on cutaneous vasculitis. Semin Cutan Med Surg. 2006;25(4):221–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Lotti T, Ghersetich I, Comacchi C, Jorizzo JL. Cutaneous small vessel vasculitis. J Am Acad Dermatol. 1998;39:667–87.CrossRefPubMedGoogle Scholar
  9. 9.
    King B. Is this leg ulcer venous? Unusual aetiologies of lower leg ulcers. J Wound Care. 2004;13:394–6.CrossRefPubMedGoogle Scholar
  10. 10.
    Trent JT, Kirsner RS. Leg ulcers in sickle cell disease. Adv Skin Wound Care. 2004;17(8):410–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Dean SM. Atypical ischemic lower extremity ulcerations: a differential diagnosis. Vasc Med. 2008;13:47–54.CrossRefPubMedGoogle Scholar
  12. 12.
    Tiwary S, Shankar R, Khanna R, Khanna A. Symmetrical peripheral gangrene. Int J Surg. 2005;7:2.Google Scholar
  13. 13.
    Franklin C, Stoffels-Weindorf M, Hillen U, Dissemond J. Ulcerated necrobiosis lipoidica as a rare cause for chronic leg ulcers: case report series of ten patients. Int Wound J. 2013. doi: 10.1111/iwj.12159.PubMedGoogle Scholar
  14. 14.
    Lacroix R, Kalisiak M, Rao J. Can you identify this condition? Can Fam Physician. 2008;54(6):857–67.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Harper P, Wahlin S. Treatment options in acute porphyria, porphyria cutanea tarda and erythropoietic protoporphyria. Curr Treat Options Gastroenterol. 2007;10(6):444–55.CrossRefPubMedGoogle Scholar
  16. 16.
    Bassi JL, Mahindra P, Singh J. Bilateral upper and lower limb ulcers due to gout- a case report. Ind J Orthop. 2006;40:53–4.CrossRefGoogle Scholar
  17. 17.
    Bliss DE. Calciphylaxis: what nurses need to know. Nephrol Nurs J. 2002;29(5):433–8.PubMedGoogle Scholar
  18. 18.
    Chertow GM, Raggi P, McCarthy JT, et al. The effects of sevelamer and calcium acetate on proxies of atherosclerotic and arteriosclerotic vascular disease in hemodialysis patients. Am J Nephrol. 2003;23:307–14.CrossRefPubMedGoogle Scholar
  19. 19.
    Moss J, Syrengelas A, Antaya R, Lazova R. Calcinosis cutis: a complication of intravenous administration of calcium gluconate. J Cutan Pathol. 2006;33 Suppl 2:60–2.CrossRefPubMedGoogle Scholar
  20. 20.
    Walker SL, Lockwood DNJ. Leprosy. Clin Dermatol. 2007;25:165–72.CrossRefPubMedGoogle Scholar
  21. 21.
    Barreto JG, Salgado CG. Clinic-epidemiological evaluation of ulcers in patients with leprosy sequelae and the effect of low level laser therapy on wound healing: a randomized clinical trial. BMC Infect Dis. 2010;10:237.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Su WP, Davis MD, Weening RH, et al. Pyoderma gangrenosum. Clinicopathologic correlation and proposed diagnostic criteria. Int J Dermatol. 2004;43(11):790–800.CrossRefPubMedGoogle Scholar
  23. 23.
    Potthoff A, Brockmeyer NH. HIV-associated Kaposi sarcoma: pathogenesis and therapy. J Dtsch Dermatol Ges. 2007;5(12):1091–4.CrossRefPubMedGoogle Scholar
  24. 24.
    Jain A, Varma A, Mangalanandan Kumar PH, Bal A. Surgical outcome of necrotizing fasciitis in diabetic lower limbs. J Diab Foot Complications. 2009;1(4):80–4.Google Scholar
  25. 25.
    Tiwary SK, Khanna AK, Kumar P, Khanna R, Khanna A. A case series describing 118 patients with lower limb necrotizing fasciitis. Int J Low Extrem Wounds. 2009;8:112–6.CrossRefPubMedGoogle Scholar
  26. 26.
    Khanna AK, Khanna A, Asthana AK, Misra MK. Mitomycin C extravasation ulcers. J Surg Oncol. 1985;28:108–10.CrossRefPubMedGoogle Scholar

Copyright information

© Springer India 2016

Authors and Affiliations

  1. 1.Department of General SurgeryInstitute of Medical Sciences, Banaras Hindu UniversityVaranasiIndia
  2. 2.Department of Community MedicineMaulana Azad Medical CollegeNew DelhiIndia

Personalised recommendations