Differential Diagnosis
Common Causes
| Venous stasis dermatitis | Peripheral artery disease | Neuropathic ulcer | |
|---|---|---|---|
| History | Prior DVT, stroke, or miscarriages Obesity, multiple pregnancies Pain on prolonged standing |
Smoking Diabetes Dyslipidemia Claudication |
Diabetes Other causes of a peripheral neuropathy |
| Location | Gaiter distribution Medial more than lateral malleolus |
Pressure points Distal points, such as toes |
Pressure points |
| Pain | Mild to moderate | Severe | None |
| Morphology | Shallow, with irregular borders | Punched-out, with necrotic eschar | Punched out |
| Skin | Venous stasis dermatitis and lipodermatosclerosis | Shiny, hairless atrophic skin | Callous surrounding the ulcer |
| Other findings | Varicose veins Peripheral edema |
Weak/absent pulses Delayed cap refill Pallor on elevation (45º for 1 min) |
Peripheral neuropathy |
Uncommon Causes
- Trauma or burns
- Infection, including ecthyma (from Streptococcus pyogenes) and ecthyma gangrenosum (from Pseudomonas)
- Vasculopathy
- Vasculitis
- Livedoid vasculopathy
- Thromboangiitis obliterans (Buerger disease)
- Microvascular occlusion disorders: cryoglobulinemia, cholesterol embolism, oxalosis, calciphylaxis
- Sickle cell disease
- Pyoderma gangrenosum
- Panniculitis
- Malignancy
- Drugs
- Brown recluse spider bite
