Lower leg ulcer: Difference between revisions
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+ | ==Differential Diagnosis== |
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+ | ===Common Causes=== |
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| − | ! |
+ | ![[Venous stasis dermatitis]] |
| + | ![[Peripheral artery disease]] |
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| − | ! Arterial |
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| − | ! |
+ | ![[Neuropathic ulcer]] |
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+ | |History |
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+ | |Prior [[DVT]], [[stroke]], or miscarriages<br />[[Obesity]], multiple pregnancies<br />Pain on prolonged standing |
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+ | |Smoking<br />[[Diabetes]]<br />[[Dyslipidemia]]<br />[[Claudication]] |
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+ | |[[Diabetes]]<br />Other causes of a peripheral neuropathy |
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+ | |Location |
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+ | |Gaiter distribution<br />Medial more than lateral malleolus |
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+ | |Pressure points<br />Distal points, such as toes |
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+ | |Pressure points |
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+ | |Pain |
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+ | |Mild to moderate |
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+ | |Severe |
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+ | |None |
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+ | |Morphology |
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+ | |Shallow, with irregular borders |
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+ | |Punched-out, with necrotic eschar |
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+ | |Punched out |
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+ | |Skin |
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+ | |Venous stasis dermatitis and lipodermatosclerosis |
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+ | |Shiny, hairless atrophic skin |
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+ | |Callous surrounding the ulcer |
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+ | |Other findings |
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+ | |Varicose veins<br />Peripheral edema |
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+ | |Weak/absent pulses<br />Delayed cap refill<br />Pallor on elevation (45º for 1 min) |
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+ | |Peripheral neuropathy |
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| − | === |
+ | ===Uncommon Causes=== |
| − | * |
+ | *Trauma or burns |
| − | * |
+ | *Infection, including [[ecthyma]] (from [[Streptococcus pyogenes]]) and [[ecthyma gangrenosum]] (from [[Pseudomonas]]) |
| − | * |
+ | *Vasculopathy |
| − | ** |
+ | **[[Vasculitis]] |
| − | ** |
+ | **[[Livedoid vasculopathy]] |
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+ | **[[Thromboangiitis obliterans]] (Buerger disease) |
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+ | **Microvascular occlusion disorders: [[cryoglobulinemia]], [[cholesterol embolism]], [[oxalosis]], [[calciphylaxis]] |
| − | ** |
+ | **[[Sickle cell disease]] |
| − | * |
+ | *[[Pyoderma gangrenosum]] |
| − | * |
+ | *[[Panniculitis]] |
| − | * |
+ | *Malignancy |
| − | * |
+ | *Drugs |
| − | * |
+ | *Brown recluse spider bite |
[[Category:Dermatology]] |
[[Category:Dermatology]] |
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Latest revision as of 10:22, 12 March 2021
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
