Chief Corner: Diagnosis and management of venous stasis ulcerations

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Key features of VENOUS ulceration include:

  • Location: most often on or near the lateral malleolus
  • Associated with: stasis dermatitis OR chronic peripheral edema of any cause
  • On exam: dermatitis, dark discoloration (postinflammatory hyperpigmentation), “woody” induration (lipodermatosclerosis), usually shallow ulceration
  • Treatment: leg elevation, leg exercises, compression bandage (if arterial supply adequate), stockings, Pentoxyfilline, ASA

Key features of ARTERIAL ulceration include:

  • Location: lower extremities
  • Associated with: peripheral atherosclerotic disease
  • On exam: more demarcated, often painful; surrounding skin either white or erythematous; loss of leg hair.
  • Treatment: revascularization, antiplatelet agents, risk factor management

Authored by: JAVIER BAEZ, MD

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Internal Medicine Chiefs