Approach to the differential diagnosis of leg ulcers
- Marta J Petersen, MD
Marta J Petersen, MD
- Professor of Dermatology
- University of Utah School of Medicine, Department of Dermatology
Leg ulcers are an increasing problem worldwide and represent a major healthcare burden. Patients with leg ulcers are managed by clinicians in multiple specialties, including primary care, vascular surgery, plastic surgery, podiatry, wound care, and dermatology.
A leg ulcer is a physical finding that can result from multiple etiologies, rather than a diagnosis (table 1). Thus, determination of the cause is essential for selecting appropriate treatment and determining the need for further evaluation. The most common causes of leg ulcers are venous insufficiency, arterial insufficiency, and neuropathic disease (table 2).
The etiologies and approach to the differential diagnosis of leg ulcers will be reviewed here. Specific etiologies of leg ulcers and wound management are reviewed in detail separately.
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- COMMON CAUSES
- Venous insufficiency
- Arterial insufficiency
- LESS COMMON CAUSES
- Physical injury
- - Vasculitis
- - Livedoid vasculopathy
- - Thromboangiitis obliterans
- - Microvascular occlusion disorders
- - Sickle cell disease
- Pyoderma gangrenosum
- Brown recluse spider bite
- PATIENT EVALUATION
- Physical examination
- Additional tests
- INDICATIONS FOR REFERRAL
- SUMMARY AND RECOMMENDATIONS