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Dermatology
UlcersAriela Hafner and Eli Sprecher
Built from Dermatology, 5th Edition
What’s inside
9 sections · 156 slides
Overview
- What this topic covers
- Terms you will meet
- Key features
- $3B/yr
Classifying Leg Ulcers
A wound reaching through the epidermis and dermis, and the three-way split used to find its cause
- What makes a wound chronic
- Classification of causes of leg ulcers
- Three main types of leg ulcer
- Telling the three types apart
- Comparing venous, arterial, and neuropathic leg ulcers — Venous
- Comparing venous, arterial, and neuropathic leg ulcers — Arterial
- Comparing venous, arterial, and neuropathic leg ulcers — Neuropathic/mal perforans
Venous Ulcers
The most common leg ulcer, caused by sustained high pressure in the vein system
- How common is chronic venous disease
- Normal blood flow up the leg
- Normal versus incompetent venous valve flow
- Venous hypertension: the shared endpoint
- From venous hypertension to skin damage
- Older theories of ulcer formation
- Theories of venous ulcer formation
- Why hemosiderin turns skin brown
- Symptoms of venous disease
- Where and how venous ulcers look
- Venous ulcer with stasis dermatitis
- Venous ulcer of the medial malleolus
- Four other skin clues of venous hypertension
- Cutaneous findings of venous hypertension
- Hemosiderin discoloration of the shins
- Atrophie blanche
- Lipodermatosclerosis
- Lipodermatosclerosis of the pannus
- Acroangiodermatitis (pseudo-Kaposi sarcoma)
- Grading venous disease: the CEAP system
- What a biopsy shows
- Ruling out other causes
- History and physical examination of a leg ulcer
- Livedoid vasculopathy and clotting risk
- Livedoid vasculopathy
- Why check for a clotting disorder
- Thrombophilia and hypercoagulability evaluation
- General principles of ulcer care
- Moisture beats dryness
- Debridement: clearing dead tissue
- Sharp and mechanical debridement
- Autolytic and enzymatic debridement
- Maggot debridement therapy
- Choosing a wound dressing
- Types of wound dressings — Properties
- Types of wound dressings — Properties (continued)
- Types of wound dressings — Disadvantages
- Types of wound dressings — Indications
- Colonization versus true infection
- Recognizing a truly infected wound
- Topical antimicrobials
- Silver as an antiseptic
- Don't forget tetanus
- Compression: the backbone of venous ulcer care
- Classes of compression stockings
- Types of compression therapy — Advantages
- Types of compression therapy — Disadvantages
- Classes of compression bandages
- Classes of compression bandages (continued)
- When compression can harm
- Manual lymph drainage
- Negative pressure wound therapy (VAC)
- Skin substitutes
- Topical and oral medicines
- Approach to the venous ulcer patient
Lymphedema
Fluid buildup from poor lymph drainage, and the skin changes that follow
- Lymphedema versus ordinary edema
- Primary lymphedema by age of onset
- Bilateral primary lymphedema (Milroy disease)
- Genetic causes of primary lymphedema
- Causes of lymphedema
- Causes of lymphedema (continued)
- Secondary lymphedema causes
- Secondary lymphedema from obesity and myxedema
- The lymphedema-infection cycle
- How lymphedema progresses
- Elephantiasis nostras verrucosa
- Elephantiasis nostras verrucosa
- Fibrotic papules in elephantiasis nostras verrucosa
- Treating lymphedema and its complications
- Other conditions that mimic lymphedema
- Lipedema of the lower legs
Arterial Ulcers
Ulcers from poor artery blood flow: peripheral artery disease
- Peripheral artery disease (PAD) basics
- Why poor blood flow causes ulcers
- Symptoms as PAD worsens
- What an arterial ulcer looks like
- Arterial ulcer
- Other clues of poor artery flow
- Measuring the ankle-brachial index (ABI)
- Determination and interpretation of the ABI
- Other tests for artery disease
- Look-alikes of arterial ulcers
- Cholesterol emboli
- Treating arterial ulcers
Diabetic and Neuropathic Ulcers
Nerve damage, not just poor circulation, is the leading cause of diabetic foot ulcers
- A major burden of diabetes
- Three types of diabetic neuropathy
- Consequences of diabetic neuropathy
- PAD adds to diabetic ulcer risk
- What a diabetic ulcer looks like
- Neuropathic (mal perforans) ulcers
- Mal perforans ulcers of the great toes
- Working up a diabetic foot ulcer
- Off-loading: taking pressure off the ulcer
- Wound care specifics for diabetic ulcers
- Growth factors and skin substitutes
- Preventing diabetic foot ulcers
Pressure Ulcers
Ulcers from sustained pressure on skin trapped between a bone and an outer surface
- What is a pressure ulcer
- Common sites for pressure ulcers
- How common and costly
- Four causes of pressure ulcers
- Pressure and time both matter
- How shear and friction add to damage
- Staging pressure ulcers: Stage I and II
- Staging pressure ulcers: Stage III and IV
- NPUAP pressure ulcer staging
- Stage III sacral pressure ulcer
- Black eschar of the heel
- Sacral decubitus ulcer
- Pressure ulcer in a wheelchair-bound patient
- What the biopsy shows
- Preventing and treating pressure ulcers
- Treatment by stage
Other Causes of Skin Ulceration
Rarer causes to consider when an ulcer resists standard treatment
- When to think 'rare cause'
- Diffuse dermal angiomatosis
- Blood disorders and ulcers
- Phlegmasia cerulea dolens
- Tropical ulcers
- A wide range of additional causes
- Additional causes of cutaneous ulceration
- Diffuse dermal angiomatosis
- Drug-related ulcers
- A genetic cause: prolidase deficiency
- Prolidase deficiency with spontaneous ulcers
- Reference table lead-in
- Additional causes of cutaneous ulceration
- Additional causes of cutaneous ulceration (continued)
- Additional causes of cutaneous ulceration (continued)
- Additional causes of cutaneous ulceration (continued)
- Additional causes of cutaneous ulceration (continued)
- Additional causes of cutaneous ulceration (continued)
- Additional causes of cutaneous ulceration (continued)
- Additional causes of cutaneous ulceration (continued)
Putting It Together
The big ideas to carry forward from this chapter on ulcers
- Match the exam to the cause
- Two goals of treatment, every time
- Prevention pays off
- References
- References (continued 2/10)
- References (continued 3/10)
- References (continued 4/10)
- References (continued 5/10)
- References (continued 6/10)
- References (continued 7/10)
- References (continued 8/10)
- References (continued 9/10)
- References (continued 10/10)
- Dermatology, 5th Edition (2-Volume Set)