Skin Ulcers

CLINICAL DIAGNOSTIC MANUAL

Skin ulcers are open lesions that affect the layers of the skin and sometimes the underlying tissues. They are typically the result of disrupted blood circulation, prolonged pressure on an area, or chronic infection. These lesions can vary in size, depth, and severity and are often associated with pain, inflammation, and sometimes discharge. Skin ulcers are a common complication in patients with reduced mobility, vascular diseases, or healing problems.

Pathology	Symptoms and Clinical Signs	Suspected Diagnosis	Confirmatory Diagnosis
Pressure ulcers	Lesions on bony prominences, reddened or necrotic skin, pain, discharge.	History of immobility or prolonged bed rest. Physical examination.	Confirmation with physical examination and ulcer staging.
Venous ulcer	Lesion on the inner ankle, moderate pain, chronic edema.	History of chronic venous insufficiency. Physical examination.	Confirmation with venous Doppler ultrasound.
Arterial ulcer	Painful lesions on distal areas (toes, heels), cold skin, diminished pulse.	History of peripheral arterial disease. Physical examination.	Confirmation with arterial Doppler ultrasound and arteriography.
Diabetic ulcer	Painless lesions on the feet, dry skin, necrosis, signs of peripheral neuropathy.	History of diabetes mellitus, poor glycemic control. Physical examination.	Confirmation with culture, X-ray to rule out osteomyelitis.
Pyoderma gangrenosum	Painful lesion starting as a pustule and rapidly ulcerating, irregular edges.	History of inflammatory bowel disease or arthritis. Physical examination.	Confirmation with skin biopsy and medical history.
Cutaneous leishmaniasis	Chronic painless ulcers with raised edges, history of exposure to endemic areas.	History of travel to endemic areas. Physical examination.	Confirmation with smear and culture of the ulcer.
Squamous cell carcinoma	Chronic ulcer that does not heal, raised edges, possible bleeding.	History of prolonged sun exposure. Physical examination.	Confirmation with biopsy and histopathological analysis.
Vasculitis	Painful ulcers on the lower limbs, signs of systemic inflammation, palpable purpura.	History of autoimmune diseases. Physical examination.	Confirmation with skin biopsy and immunological studies.
Marjolin’s ulcer	Chronic ulcer arising from a previous scar or lesion, hard and irregular edges.	History of previous scar or burn. Physical examination.	Confirmation with lesion biopsy.