Aetiology

Causes include:

• vascular (1)
  • venous - ulceration following deep venous thrombosis, varicose veins
  • arterial - ischaemia, atherosclerosis, arteriovenous malformation
  • mixed
  • vasculitis - systemic lupus erythematosis, rheumatoid arthritis, scleroderma, polyarteritis nodosa, Wegener's granulomatosis
  • lymphatic
• neuropathic - diabetes, tabes dorsalis, spina bifida, leprosy in endemic areas, peripheral neuropathy (1)
• metabolic - diabetes, gout,
• haematological - haemolytic anaemia, especially sickle cell disease, hereditary spherocytosis, polycythaemia rubra vera
• malignancy - usually squamous cell skin carcinoma. Also Marjolin's ulcer or Bowen's disease
• rheumatoid arthritis - ulceration is multifactorial
• panniculitis - necrobiosis lipoidica - may be diabetic
• gumma
• pyoderma gangrenosum - often associated with ulcerative colitis
• trauma e.g. traumatic flap lacerations over the shin; artefact, burns, cold injury, pressure sore, radiation, factitious (1)

Many leg ulcers have a multifactorial aetiology e.g. arterial ischaemia, venous hypertension, anaemia, infection (2).

Reference:

• (1) Agale SV. Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management. Ulcers 2013;vol. 2013, Article ID 413604, 9 pages
• (2) Simon DA, Dix FP, McCollum CN. Management of venous leg ulcers. BMJ 2004;328:1358-1362