|Basal Cell Carcinoma
|Squamous Cell Carcinoma
|Mycosis Fungoides (Sezary Syndrome)
|Pityriasis/Tinea versicolor infections
|Toxic Epidermal Necrolysis
|Atopic Eczema/Atopic Dermatitis
Every ulcerated skin lesion ask could this be pyoderma
- Can easily be dismissed as just another ulcer.
- Always consider other causes than the common venous leg ulcer.
- Always be on the lookout for skin cancers and other diseases masquerading as simple venous ulcers.
- If in doubt dermatology referral and biopsy.
- Painful ulcer - the patient may be "off feet" can progress rapidly
- Ulcer may even occur around a colostomy
- Type of skin lesion preceding the ulcer (papule, pustule, or vesicle)
- Possibly minor trauma (pathergy) preceding development of the ulcer
- Red violaceous purplish borders
- Coexisting disease - Rheumatoid, Ulcerative colitis, Myeloma etc.
- Drug history - hydroxyurea, or granulocyte-macrophage colony-stimulating factor)
- No cause found 20%
- Inflammatory bowel disease
- Lymphoma and Leukaemia
- Multiple myeloma
- Primary biliary cirrhosis
- Rheumatoid arthritis
- Skin grafts and surgery are not treatment options as they often fail and may cause enlargement of the ulcer.
- Local applications to the skin (topical treatments): Strong steroid preparations or calcineurin inhibitors (tacrolimus) applied topically to the affected skin often help, especially with small ulcers, and may help to reduce the pain.
- Antibiotics (e.g. minocycline) or dapsone may be useful when treating small ulcers. Dapsone can cause anaemia and needs monitored. Dapsone also causes some patients to have headaches.
- Steroids (e.g. Prednisolone) may be used alone or in combination with other immunosuppressive agents.
- Immunosuppression: Mycophenolate mofetil, Ciclosporin, Azathioprine. In very severe disease cyclophosphamide, intravenous steroids or immunoglobulins or biologic treatments.