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   Caption        = Disseminated Intravascular Coagulation: Gross view of thighs and legs at autopsy ecchymoses with central necrosis and ulceration looks like [[pyoderma gangrenosum]]. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>|}}
   Caption        = Disseminated Intravascular Coagulation: Gross view of thighs and legs at autopsy ecchymoses with central necrosis and ulceration looks like [[pyoderma gangrenosum]]. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>|}}
{{SI}}
{{SI}}
{{CMG}}; {{VR}}
{{CMG}}; {{AE}} {{VR}}


==Overview==
==Overview==
'''Leg ulcer'''s usually refer to ulcers of the lower leg. The most common cause of leg ulcers is [[venous insufficiency]].  
Leg ulcers usually refer to ulcers of the lower leg. The most common cause of leg ulcers is [[venous insufficiency]].


==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
*[[Aneurysm]]
*[[Aneurysm]]
*[[Arterial thrombosis]]
*[[Arterial thrombosis]]
*[[Arteriovenous fistula]]
*[[Arterio-venous malformation]]
*[[Blood clot]]
*[[Blood clot]]
*[[Burns]]
*[[Burns]]
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*[[Immersion foot|Cold injury]]
*[[Immersion foot|Cold injury]]
*[[Deep vein thrombosis]]
*[[Deep vein thrombosis]]
*[[Dehydration]]
*[[Delirium]]
*[[Gas gangrene]]
*[[Gas gangrene]]
*[[Osteomyelitis]]
*[[Osteomyelitis]]
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{|style="width:82%; height:100px" border="1"
{|style="width:82%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Allergic vasculitis]], [[anemia]], [[aneurysm]], [[angiosarcoma]], [[arterial insufficiency]], [[arterial thrombosis]], [[arterio-venous malformation]], [[arteriovenous fistula]], [[arteriovenous malformation]], [[atheroma]], [[atherosclerosis]], [[cholesterol embolism]], [[venous insufficiency]], [[Churg-Strauss syndrome]], [[congestive heart failure]], [[deep vein thrombosis]], [[dehydration]], [[diabetes mellitus]], [[embolism]], [[fibromuscular dysplasia]], [[heart failure]], [[hypertension]], [[hypotension]], [[hypothermia]], [[kaposi's sarcoma]], [[leukocytoclastic vasculitis]], [[livedoid vasculopathy]], [[lymphangitis]], [[lymphatic obstruction]], [[Lymphedema|lymphatic vessel dysplasia]], [[lymphedema]], [[peripheral artery disease]], [[polyarteritis nodosa]], [[polyarteritis]], [[post-thrombotic syndrome]], [[raynaud's syndrome]], [[sepsis]], [[septic emboli]], [[thromboangiitis obliterans]], [[thrombotic thrombocytopenic purpura]], [[varicose veins]], [[vasculitis]], [[Chronic Venous insufficiency|venous valvular incompetence]], [[Wegener's granulomatosis]]
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Allergic vasculitis]], [[anemia]], [[aneurysm]], [[angiosarcoma]], [[arterial insufficiency]], [[arterial thrombosis]], [[arterio-venous malformation]], [[arteriovenous fistula]], [[arteriovenous malformation]], [[atheroma]], [[atherosclerosis]], [[cholesterol embolism]], [[venous insufficiency]], [[Churg-Strauss syndrome]], [[congestive heart failure]], [[deep vein thrombosis]], [[Degos disease]], [[dehydration]], [[diabetes mellitus]], [[embolism]], [[fibromuscular dysplasia]], [[heart failure]], [[hypertension]], [[hypotension]], [[hypothermia]], [[kaposi's sarcoma]], [[leukocytoclastic vasculitis]], [[livedoid vasculopathy]], [[lymphangitis]], [[lymphatic obstruction]], [[Lymphedema|lymphatic vessel dysplasia]], [[lymphedema]], [[Degos disease|papulosis maligna atrophicans]], [[peripheral artery disease]], [[polyarteritis nodosa]], [[polyarteritis]], [[post-thrombotic syndrome]], [[Raynaud's syndrome]], [[sepsis]], [[septic emboli]], [[thromboangiitis obliterans]], [[thrombotic thrombocytopenic purpura]], [[varicose veins]], [[vasculitis]], [[Chronic Venous insufficiency|venous valvular incompetence]], [[Wegener's granulomatosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Chemical/Poisoning'''
| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Arsenic]]
|bgcolor="Beige"| [[Arsenic]], [[Spider bite|spider bites]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| [[Acquired perforating dermatosis]], [[actinic keratosis]], [[advanced age]], [[allergic vasculitis]], [[Amoebiasis|amebiasis cutis]], [[contact dermatitis]], [[Skin trauma|continuous trauma]], [[Crohn's disease]], [[Lymphoma|cutaneous lymphoma ulcers]], [[decubitus ulcer]], [[Ecthyma gangrenosum | ecthyma]], [[erysipelas]], [[Bazin disease | erythema induratum of bazin]], [[filariasis]], [[furuncle]], [[glanders]], [[herpes simplex]], [[incontinence]], [[keratoacanthoma]], [[Eumycetoma | madura foot]], [[melanoma]], [[porphyria cutanea tarda]], [[Bedsore|prolonged immobilization]], [[radiodermatitis]], [[sporotrichosis]], [[squamous cell carcinoma]], [[ulcerative colitis]], [[xeroderma pigmentosum]]  
|bgcolor="Beige"| [[Acquired perforating dermatosis]], [[actinic keratosis]], [[advanced age]], [[allergic vasculitis]], [[Amoebiasis|amebiasis cutis]], [[contact dermatitis]], [[Skin trauma|continuous trauma]], [[Crohn's disease]], [[Lymphoma|cutaneous lymphoma ulcers]], [[decubitus ulcer]], [[Ecthyma gangrenosum | ecthyma]], [[erysipelas]], [[Bazin disease | erythema induratum of bazin]], [[filariasis]], [[furuncle]], [[glanders]], [[herpes simplex]], [[keratoacanthoma]], [[Eumycetoma | madura foot]], [[melanoma]], [[porphyria cutanea tarda]], [[Bedsore|prolonged immobilization]], [[radiodermatitis]], [[sporotrichosis]], [[squamous cell carcinoma]], [[ulcerative colitis]], [[xeroderma pigmentosum]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Crohn's disease]], [[incontinence]], [[ulcerative colitis]]
|bgcolor="Beige"| [[Crohn's disease]], [[ulcerative colitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| [[Delirium]]
|bgcolor="Beige"| [[Delirium]], [[Factitious disorder|factitious ulceration]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Calciphylaxis]], [[incontinence]]
|bgcolor="Beige"| [[Calciphylaxis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| [[Amyloidosis]], [[decubitus ulcer]], [[Factitious disorder|factitious ulceration]], [[friction]], [[Malnutrition|low weight]], [[Marjolin's ulcer]], [[Ulcer|moisture in the form of perspiration, feces, or urine]], [[The Heart in Köhlmeier-Degos Disease|papulosis maligna atrophicans]], [[Bedsore|prolonged immobilization]], [[sarcoidosis]], [[Spider bite|spider bites]]
|bgcolor="Beige"| [[Amyloidosis]], [[decubitus ulcer]], [[friction]], [[underweight|low weight]], [[Marjolin's ulcer]], [[Bedsore|prolonged immobilization]], [[sarcoidosis]]
|-
|-
|}
|}
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*[[Decubitus ulcer]]
*[[Decubitus ulcer]]
*[[Deep vein thrombosis]]
*[[Deep vein thrombosis]]
* [[Degos disease]]
*[[Dehydration]]
*[[Dehydration]]
*[[Delirium]]
*[[Delirium]]
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*[[Erysipelas]]
*[[Erysipelas]]
*[[Bazin disease | Erythema induratum of bazin]]
*[[Bazin disease | Erythema induratum of bazin]]
{{col-break|width=33%}}
*[[Essential thrombocythemia]]
*[[Essential thrombocythemia]]
{{col-break|width=33%}}
*[[Chemotherapy | Extravasated cytostatic agents]]
*[[Chemotherapy | Extravasated cytostatic agents]]
*[[Factitious disorder|Factitious ulceration]]
*[[Factitious disorder|Factitious ulceration]]
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*[[Hypotension]]
*[[Hypotension]]
*[[Hypothermia]]
*[[Hypothermia]]
*[[Incontinence]]
*[[Ionizing radiation]]
*[[Ionizing radiation]]
*[[Kala-azar]]
*[[Kala-azar]]
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*[[Leukocytoclastic vasculitis]]
*[[Leukocytoclastic vasculitis]]
*[[Livedoid vasculopathy]]
*[[Livedoid vasculopathy]]
*[[Malnutrition|Low weight]]
*[[Underweight|Low weight]]
*[[Sciatica|Lower limb nerve injury]]
*[[Sciatica|Lower limb nerve injury]]
*[[Syphilis | Lues maligna]]
*[[Syphilis | Lues maligna]]
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*[[Melanoma]]
*[[Melanoma]]
*[[Methotrexate]]
*[[Methotrexate]]
*[[Ulcer|Moisture in the form of perspiration, feces, or urine]]
*[[Multiple sclerosis]]
*[[Multiple sclerosis]]
*[[Mycobacterium ulcerans]]
*[[Mycobacterium ulcerans]]
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*[[Necrobiosis lipoidica]]
*[[Necrobiosis lipoidica]]
*[[Neuropathy]]
*[[Neuropathy]]
*[[Osteomyelitis]]
{{col-break|width=33%}}
{{col-break|width=33%}}
*[[Osteomyelitis]]
*[[Human papillomavirus|Papillomatosis cutis carcinoides]]
*[[Human papillomavirus|Papillomatosis cutis carcinoides]]
*[[The Heart in Köhlmeier-Degos Disease|Papulosis maligna atrophicans]]
*[[Degos disease|Papulosis maligna atrophicans]]
*[[Pemphigus vulgaris]]
*[[Pemphigus vulgaris]]
*[[Penicillin]]
*[[Penicillin]]
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*[[Porphyria cutanea tarda]]
*[[Porphyria cutanea tarda]]
*[[Post-thrombotic syndrome]]
*[[Post-thrombotic syndrome]]
*[[Polycythemia vera | Primary polycythemia]]
*[[Polycythemia vera |Primary polycythemia]]
*[[Primary thrombocythemia]]
*[[Primary thrombocythemia]]
*[[Prolidase deficiency]]
*[[Prolidase deficiency]]
*[[Bedsore|Prolonged Immobilization]]
*[[Bedsore|Prolonged immobilization]]
*[[Protein C deficiency]]
*[[Protein C deficiency]]
*[[Protein S deficiency]]
*[[Protein S deficiency]]
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*[[Yaws]]
*[[Yaws]]
{{col-end}}
{{col-end}}
==Differential Diagnosis of Leg Ulcer==
* [[Anemia]]
* [[Arteriosclerosis]]
* [[Arteriovenous malformation]]
* [[Basal cell carcinoma]]
* [[Blastomycosis]]
* [[Blister | Bullous Disease]]
* [[Buerger's disease]]
* [[Burns]]
* [[Cellulitis]]
* [[Coccidiomycosis]]
* [[Cold agglutinin disease]]
* [[Immersion foot|Cold injury]]
* [[Congestive heart failure]]
* [[Contact dermatitis]]
* [[Decubitus ulcer]]
* [[Deep vein thrombosis]]
* [[Diabetes mellitus]]
* [[Diabetic neuropathy]]
* [[Drugs]]
* [[Impetigo | Ecthyma]]
* [[Embolism]]
* [[Furuncle]]
* [[Gaucher's disease]]
* [[Gout]]
* [[Histoplasmosis]]
* [[Insect bites]]
* [[Kaposi's sarcoma]]
* [[Leprosy]]
* [[Leukemia]]
* [[Lymphangitis]]
* [[Lymphedema]]
* [[Macroglobulinemia]]
* [[Malnutrition]]
* [[Melanoma]]
* [[Metastasis]]
* [[Mycosis fungoides]]
* [[Osteomyelitis]]
* [[Allergy history and symptoms|Other allergic conditions]]
* [[Peripheral vascular disease]]
* [[Polyarteritis]]
* [[Polycythemia vera]]
* [[Protozoan infection]]
* [[Protein C deficiency]]
* [[Protein S deficiency]]
* [[Radiation]] [[dermatitis]]
* [[Raynaud's syndrome]]
* [[Rheumatoid arthritis]]
* [[Scleroderma]]
* [[Septic emboli]]
* [[Sickle cell anemia]]
* [[Sporotrichosis]]
* [[Squamous cell carcinoma]]
* [[Syringomyelia]]
* [[Systemic Lupus Erythematosus]]
* [[Tabes dorsalis]]
* [[Thalassemia]]
* [[Trauma]]
* [[Tuberculosis]]
* [[Venous insufficiency]]<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref><ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>


== References ==
== References ==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Crowdiagnosis]]
[[Category:Dermatology]]
[[Category:Dermatology]]
[[Category:Signs and symptoms]]
[[Category:Up-To-Date]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 18:12, 9 June 2015

Leg ulcer
Disseminated Intravascular Coagulation: Gross view of thighs and legs at autopsy ecchymoses with central necrosis and ulceration looks like pyoderma gangrenosum.
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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List of terms related to Leg ulcer

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vendhan Ramanujam M.B.B.S [2]

Overview

Leg ulcers usually refer to ulcers of the lower leg. The most common cause of leg ulcers is venous insufficiency.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Allergic vasculitis, anemia, aneurysm, angiosarcoma, arterial insufficiency, arterial thrombosis, arterio-venous malformation, arteriovenous fistula, arteriovenous malformation, atheroma, atherosclerosis, cholesterol embolism, venous insufficiency, Churg-Strauss syndrome, congestive heart failure, deep vein thrombosis, Degos disease, dehydration, diabetes mellitus, embolism, fibromuscular dysplasia, heart failure, hypertension, hypotension, hypothermia, kaposi's sarcoma, leukocytoclastic vasculitis, livedoid vasculopathy, lymphangitis, lymphatic obstruction, lymphatic vessel dysplasia, lymphedema, papulosis maligna atrophicans, peripheral artery disease, polyarteritis nodosa, polyarteritis, post-thrombotic syndrome, Raynaud's syndrome, sepsis, septic emboli, thromboangiitis obliterans, thrombotic thrombocytopenic purpura, varicose veins, vasculitis, venous valvular incompetence, Wegener's granulomatosis
Chemical/Poisoning Arsenic, spider bites
Dental No underlying causes
Dermatologic Acquired perforating dermatosis, actinic keratosis, advanced age, allergic vasculitis, amebiasis cutis, contact dermatitis, continuous trauma, Crohn's disease, cutaneous lymphoma ulcers, decubitus ulcer, ecthyma, erysipelas, erythema induratum of bazin, filariasis, furuncle, glanders, herpes simplex, keratoacanthoma, madura foot, melanoma, porphyria cutanea tarda, prolonged immobilization, radiodermatitis, sporotrichosis, squamous cell carcinoma, ulcerative colitis, xeroderma pigmentosum
Drug Side Effect Coumarin, ergotamine, cytostatic agents, halogens, hydroxyurea, leflunomide, methotrexate, penicillin, plasmin, plasminogen activator inhibitor-1, tissue plasminogen activator
Ear Nose Throat No underlying causes
Endocrine Diabetes mellitus, necrobiosis lipoidica
Environmental Burns, cold injury, contact dermatitis, heat, ionizing radiation, radiodermatitis
Gastroenterologic Crohn's disease, ulcerative colitis
Genetic Fibromuscular dysplasia, factor V Leiden mutation, Gaucher's disease, hereditary spherocytosis, Klinefelter syndrome, leukocyte adhesion deficiency, lymphatic vessel dysplasia, prolidase deficiency, tap1 mutation, thalassaemia, xeroderma pigmentosum
Hematologic Activated protein C resistance, anemia, antiphospholipid syndrome, antithrombin III deficiency, blood clot, cryoglobulinemia, deep vein thrombosis , dysproteinemia, essential thrombocythemia, factor V Leiden mutation, factor XIII deficiency, Felty's syndrome, granulocytopenia, hereditary spherocytosis, Langerhans cell histiocytosis, leukemia, leukocyte adhesion deficiency, lupus anticoagulant, macroglobulinemia, myelodysplasia, plasmin, plasminogen activator inhibitor-1, polyclonal dysproteinemia, polycythemia, polycythemia vera, primary polycythemia, primary thrombocythemia, protein C deficiency, protein S deficiency, purpura, sickle cell anemia, thalassemia, thrombotic thrombocytopenic purpura,tissue plasminogen activator
Iatrogenic Calcinosis cutis, cytostatic agents, radiodermatitis, vaccinations
Infectious Disease Actinomycosis, amoebiasis cutis, amoebiasis, anthrax, bacillary angiomatosis, bacterial infection, bacteroides, blastomycosis, borrelia vincenti, cellulitis, coccidiomycosis, cold agglutinin disease, diphtheria, ecthyma, ecthyma gangrenosum, ecthyma, erysipelas, fasciitis necroticans, filariasis, folliculitis, francisella tularensis, furuncle, gas gangrene, glanders, granuloma inguinale, haemophilus ducreyi, herpes simplex, histoplasmosis, kala-azar, leishmaniasis, leprosy, lues maligna, lymphangitis, madura foot, mycobacterium ulcerans, mycosis fungoides, osteomyelitis, papillomatosis cutis carcinoides, poliomyelitis, rodent ulcer, sepsis, septic emboli, sporotrichosis, syphilis, tinea pedis, tropical ulcer, tuberculosis, tularemia, variola virus, vasculitis, yaws
Musculoskeletal/Orthopedic Badly united fractures, bone fractures
Neurologic Alcoholic neuropathy, autonomic dysfunction, cerebral palsy, dementia, diabetic neuropathy, hemiplegia, multiple sclerosis, neuropathy, spina bifida, spinal cord injury, spinal cord lesions, syringomyelia
Nutritional/Metabolic Calcinosis cutis, calciphylaxis, gout, hyperhomocysteinemia, malnutrition, necrobiosis lipoidica, porphyria cutanea tarda,starvation
Obstetric/Gynecologic No underlying causes
Oncologic Angiosarcoma, basal cell carcinoma, cold agglutinin disease, cutaneous lymphoma ulcers, leukemia, macroglobulinemia, Marjolin's ulcer, melanoma, sarcoma, squamous cell carcinoma
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric Delirium, factitious ulceration
Pulmonary No underlying causes
Renal/Electrolyte Calciphylaxis
Rheumatology/Immunology/Allergy Rheumatoid arthritis
Sexual No underlying causes
Trauma Continuous trauma, bone fractures, lower limb nerve injury, Marjolin's ulcer, shearing forces, spinal cord injury
Urologic No underlying causes
Miscellaneous Amyloidosis, decubitus ulcer, friction, low weight, Marjolin's ulcer, prolonged immobilization, sarcoidosis

Causes in Alphabetical Order

References

  1. ↑ "Differential diagnosis of leg ulcers - Dissemond - 2006 - JDDG: Journal der Deutschen Dermatologischen Gesellschaft - Wiley Online Library". Retrieved 12 July 2013.
  2. ↑ "http://www.health.wa.gov.au/woundswest/docs/WPR_Nov09_Atypical_Leg_Ulcers.pdf" (PDF). Retrieved 12 July 2013. External link in |title= (help)

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