What is an ulcer?

A skin ulcer is an open sore that can be superficial or deep.  Oozing or drainage of blood or fluid is usually present.  There are many reasons the skin can ulcerate.  Diabetes, nerve damage, varicose vein disease, arterial disease, infections, cancer, pressure, burns and injury are typical causes.

The most common location for an ulcer is on the foot or leg.  Usually there is associated pain unless the ulcer is a result of diabetes or nerve injury. A rash, redness, brown discoloration of the skin, or dry, scaly skin may accompany an ulcer.  Leg and foot ulcers are usually not cancerous however longstanding ulcers may develop a cancer called squamous cell carcinoma.

Causes of leg or foot ulcers:

The most common cause of a leg ulcer is varicose vein disease. Also called venous stasis ulcer, this is common in patients who have a history of leg swelling, varicose veins, stasis dermatitis, or a history of blood clots in either the superficial or the deep veins of the legs. Ulcers may affect one or both legs.

Ulcers caused by poor circulation are called ischemic or arterial ulcers, and are usually located on the heels or tips of the toes.  The patient may have intermittent claudication which is leg muscle pain made worse by walking a distance or uphill.  The feet are often cold and numb with poor pulses.

Nerve damage is a third cause of leg or foot ulcers.  Since the patient's nerves do not signal pain, cracking of the skin or injury to the foot is not recognized.  It is important for these patients to inspect their feet every day to detect early problems before an ulcer starts.   Other symptoms of nerve damage may include numbness, tingling or burning pain in the feet or toes.  Diabetes causes damage to nerves and is the most common type of ulcer in this category.

Treatment of leg ulcers:

Regardless of cause, most ulcers become infected quite easily since the skin's barrier against bacteria is lost. Therefore, treatment is twofold: correction of the underlying cause and antibacterial therapy.

Venous ulcers are treated by correcting venous hypertension with EVLA, foam sclerotherapy and compression hosiery , and antibiotics and wound care dressings to speed healing of the infection. Most ulcers of this type heal within weeks of correcting the underlying venous hypertension.

Arterial ulcers are evaluated with duplex ultrasound studies and patients may require arterial bypass surgery to bring freshly oxygenated blood to the affected limb for healing of the ulcer.  Patients must stop smoking and control hypertension which both aggravate this condition.

Ulcers due to nerve damage are treated with special shoes to limit pressure on the ulcer site and frequent surgical removal of dead debris in the ulcer so it can heal.

What about ulcers due to cancer?

Ulcers due to skin cancer can form on any location of the body.  They can result from basal cell carcinoma, squamous cell carcinoma or malignant melanoma.