Leg Ulcers: Expanding the Differential

Abstract

Purpose of Review

Cutaneous lower extremity ulcerations are major source of morbidity and mortality. It can be challenging to identify an underlying etiology. This review provides a systematic framework for generating a thoughtful differential diagnosis and workup approach. We also highlight recent discoveries in the pathophysiology and treatment approaches of leg ulceration.

Recent Findings

Venous leg ulceration is being treated with a number of promising new modalities including pentoxifylline, statin therapy, topical timolol, connexin-43 peptide antagonists, photodynamic therapy, and punch grafting. The role of vitamin K deficiency is gaining prominence with regard to calciphylaxis.

Summary

Recognition of key risk factors and subtle physical exam findings can serve as clues to the underlying mechanism of cutaneous ulceration and direct a targeted workup for underlying systemic disease that may be ameliorated with appropriate therapy.