Skin ulcers typically occur when an underlying condition compromises the health of the affected skin. Problems with venous or arterial blood flow account for the majority of skin ulcers. Skin cancer may also present as ulcerations of the skin. Potential complications of skin ulcers include bacterial infection and amputation. Appropriate treatment for skin ulcers depends on the underlying cause.
Venous Stasis
Pooling of blood in the foot and lower leg, termed venous stasis, causes fluid leakage into the soft tissues. Conditions that may lead to venous stasis include varicose veins, blood clots in the leg veins, marked inactivity, heart failure and obesity. Venous stasis leads to thinning of the skin, which increases vulnerability to injury. Minor skin trauma often leads to the formation of ankle or lower leg ulcers. Healing of these lesions frequently proves slow and challenging, with a high risk for bacterial infection. The Cleveland Clinic reports that chronic venous stasis accounts for 80 to 90 percent of lower extremity ulcers in the United States.
Peripheral Arterial Disease
Peripheral arterial disease occurs when atherosclerotic plaques form in the arteries that supply blood to the lower extremities. The plaques represent an accumulation of cholesterol, inflammatory cells and fibrous tissue along the inner wall of the artery. As the plaques grow, blood flow decreases and the tissues becoming increasingly oxygen-deprived, or ischemic. "The Merck Manual for Healthcare Professionals" reports that ischemic ulcers often develop in people with advanced peripheral arterial disease. The toes and heel of the foot are common locations for ischemic ulcers. Bacterial infection, including the possible development of gangrene, commonly occurs with ischemic ulcers. In severe cases, amputation may prove necessary to halt the spread of infection.
Sickle Cell Anemia
Sickle cell anemia is an inherited disorder that leads to malformation of the red blood cells. Among other widespread effects on the body, sickle cell anemia triggers the formation of blood clots in the smallest blood vessels, the capillaries. The tissues supplied by the obstructed capillaries suffer oxygen-deprivation injury. Columbia University Medical Center explains that capillary obstruction leads to the common complication of leg ulcers, which tend to be chronic and recurrent. Males with sickle cell anemia more commonly experience leg ulcers than do females with the disease. Leg ulcers may first appear beginning at approximately age 10.
Non-Melanoma Skin Cancer
Non-melanoma skin cancers may present as skin ulcers. Typically, non-melanoma skin cancer begins as small patch or lump. As the cancer grows, the center of the lesion may ulcerate, notes "The Merck Manual for Healthcare Professionals." Skin cancer lesions characteristically fail to heal. In contrast to other types of skin ulcers that most commonly occur on the lower extremities, non-melanoma skin cancers most frequently present on sun-exposed areas of the head, neck and hands.
References
- Penn State College of Medicine, Milton S. Hershey Medical Center: Chronic Venous Insufficiency
- University of Maryland Medical Center: Stasis Dermatitis and Ulcers
- Merck Manual for Healthcare Professionals: Peripheral Arterial Disease, Signs and Symptoms
- Cleveland Clinic: Lower Extremity (Foot and Leg) Ulcers
- National Heart, Lung and Blood Institute: What are the Signs and Symptoms of Sickle Cell Anemia?
