Diagnosis: Skin ulcers
A diphtheria skin lesion on the leg. Corynebacterium diphtheriae can not only affect the respiratory system, but the skin as well, where it manifests as an open wound.. Clinical photograph sourced from Wikimedia Commons (Public domain). Attribution: CDC.
Venous: shallow, irregular, medial malleolus, surrounding stasis dermatitis and hemosiderosis. Arterial: punched out, painful, lateral malleolus or toes, pallor. Neuropathic: painless, plantar pressure points. PG: rapidly progressive, violaceous undermined borders.
Venous: chronic edema, DVT history, varicose veins. Arterial: claudication, rest pain, smoking, PAD risk factors. Diabetic: peripheral neuropathy, deformity. PG: associated with IBD, hematologic malignancies, rheumatoid arthritis.
Venous: compression therapy (gold standard), wound care, pentoxifylline. Arterial: revascularization referral. Diabetic: offloading, glucose control, wound care. PG: systemic immunosuppression (corticosteroids, cyclosporine), pathergy precautions.
Venous ulcer, Arterial ulcer, Diabetic ulcer, Pyoderma gangrenosum, Vasculitis, Calciphylaxis, Marjolin ulcer (SCC in chronic wound)
ABI (ankle-brachial index) must be checked before compression therapy — contraindicated if ABI <0.5. Pyoderma gangrenosum exhibits pathergy — debridement may worsen it. Chronic non-healing ulcers should be biopsied to exclude malignancy.
Tags: ulcer, wound, chronic, venous, vascular