Ulcer (dermatology)

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Ulcer (dermatology)_table_infobox_0

Skin ulcerUlcer (dermatology)_header_cell_0_0_0
SpecialtyUlcer (dermatology)_header_cell_0_1_0 Dermatology Q6452285?uselang=en#P1995Ulcer (dermatology)_cell_0_1_1

An ulcer is a sore on the skin or a mucous membrane, accompanied by the disintegration of tissue. Ulcer (dermatology)_sentence_0

Ulcers can result in complete loss of the epidermis and often portions of the dermis and even subcutaneous fat. Ulcer (dermatology)_sentence_1

Ulcers are most common on the skin of the lower extremities and in the gastrointestinal tract. Ulcer (dermatology)_sentence_2

An ulcer that appears on the skin is often visible as an inflamed tissue with an area of reddened skin. Ulcer (dermatology)_sentence_3

A skin ulcer is often visible in the event of exposure to heat or cold, irritation, or a problem with blood circulation. Ulcer (dermatology)_sentence_4

They can also be caused due to a lack of mobility, which causes prolonged pressure on the tissues. Ulcer (dermatology)_sentence_5

This stress in the blood circulation is transformed to a skin ulcer, commonly known as bedsores or decubitus ulcers. Ulcer (dermatology)_sentence_6

Ulcers often become infected, and pus forms. Ulcer (dermatology)_sentence_7

Signs and symptoms Ulcer (dermatology)_section_0

Skin ulcers appear as open craters, often round, with layers of skin that have eroded. Ulcer (dermatology)_sentence_8

The skin around the ulcer may be red, swollen, and tender. Ulcer (dermatology)_sentence_9

Patients may feel pain on the skin around the ulcer, and fluid may ooze from the ulcer. Ulcer (dermatology)_sentence_10

In some cases, ulcers can bleed and, rarely, patients experience fever. Ulcer (dermatology)_sentence_11

Ulcers sometimes seem not to heal; healing, if it does occur, tends to be slow. Ulcer (dermatology)_sentence_12

Ulcers that heal within 12 weeks are usually classified as acute, and longer-lasting ones as chronic. Ulcer (dermatology)_sentence_13

Ulcers develop in stages. Ulcer (dermatology)_sentence_14

In stage 1 the skin is red with soft underlying tissue. Ulcer (dermatology)_sentence_15

In the second stage the redness of the skin becomes more pronounced, swelling appears, and there may be some blisters and loss of outer skin layers. Ulcer (dermatology)_sentence_16

During the next stage, the skin may become necrotic down through the deep layers of skin, and the fat beneath the skin may become exposed and visible. Ulcer (dermatology)_sentence_17

In stage 4, deeper necrosis usually occurs, the fat underneath the skin is completely exposed, and the muscle may also become exposed. Ulcer (dermatology)_sentence_18

In the last two stages the sore may cause a deeper loss of fat and necrosis of the muscle; in severe cases it can extend down to bone level, destruction of the bone may begin, and there may be sepsis of joints. Ulcer (dermatology)_sentence_19

Chronic ulcers may be painful. Ulcer (dermatology)_sentence_20

Most patients complain of constant pain at night and during the day. Ulcer (dermatology)_sentence_21

Chronic ulcer symptoms usually include increasing pain, friable granulation tissue, foul odour, and wound breakdown instead of healing. Ulcer (dermatology)_sentence_22

Symptoms tend to worsen once the wound has become infected. Ulcer (dermatology)_sentence_23

Venous skin ulcers that may appear on the lower leg, above the calf or on the lower ankle usually cause achy and swollen legs. Ulcer (dermatology)_sentence_24

If these ulcers become infected they may develop an unpleasant odour, increased tenderness and redness. Ulcer (dermatology)_sentence_25

Before the ulcer establishes definitively, there may be a dark red or purple skin over the affected area as well as a thickening, drying, and itchy skin. Ulcer (dermatology)_sentence_26

Although skin ulcers do not seem of great concern at a first glance, they are worrying conditions especially in people suffering from diabetes, as they are at risk of developing diabetic neuropathy. Ulcer (dermatology)_sentence_27

Ulcers may also appear on the cheeks, soft palate, the tongue, and on the inside of the lower lip. Ulcer (dermatology)_sentence_28

These ulcers usually last from 7 to 14 days and can be painful. Ulcer (dermatology)_sentence_29

Discharges Ulcer (dermatology)_section_1

Different types of discharges from ulcer are: Ulcer (dermatology)_sentence_30

Ulcer (dermatology)_unordered_list_0

  • Serous, usually seen in healing ulcerUlcer (dermatology)_item_0_0
  • Purulent, seen in infected ulcer. Yellow creamy discharge is observed in staphylococcal infection; bloody opalescent discharge in streptococcal infection, while greenish discharge is seen in pseudomonas ulcerUlcer (dermatology)_item_0_1
  • Bloody (sanguineous), usually seen in malignant ulcers and in healing ulcers with healthy granulation tissueUlcer (dermatology)_item_0_2
  • SeropurulentUlcer (dermatology)_item_0_3
  • SerosanguinousUlcer (dermatology)_item_0_4
  • Serous with sulphur granules, seen in actinomycosisUlcer (dermatology)_item_0_5
  • Yellowish, as seen in tuberculous ulcerUlcer (dermatology)_item_0_6

Causes Ulcer (dermatology)_section_2

The wounds from which ulcers arise can be caused by a wide variety of factors, but the main cause is impaired blood circulation. Ulcer (dermatology)_sentence_31

Especially, chronic wounds and ulcers are caused by poor circulation, either through cardiovascular issues or external pressure from a bed or a wheelchair A very common and dangerous type of skin ulcers are caused by what are called pressure-sensitive sores, more commonly called bed sores and which are frequent in people who are bedridden or who use wheelchairs for long periods. Ulcer (dermatology)_sentence_32

Other causes producing skin ulcers include bacterial or viral infections, fungal infections and cancers. Ulcer (dermatology)_sentence_33

Blood disorders and chronic wounds can result in skin ulcers as well. Ulcer (dermatology)_sentence_34

Venous leg ulcers due to impaired circulation or a blood flow disorder are more common in the elderly. Ulcer (dermatology)_sentence_35

Rare causes of skin ulcers include pyoderma gangraenosum, lesions caused by Crohn's disease or ulcerative colitis, granulomatosis with polyangiitis, morbus Behçet, and infections that are usually seen in those who are immunocompromised, for example ecthyma gangraenosum. Ulcer (dermatology)_sentence_36

It is important to consider such causes if the skin ulcerations don't show improvement with antibiotic treatments, and when other systemic symptoms are present. Ulcer (dermatology)_sentence_37

It is advised to not use surgical procedures on ulcerations caused by Behçet or pyoderma gangraenosum, as those diseases usually exhibit pathergy. Ulcer (dermatology)_sentence_38

Diagnosis Ulcer (dermatology)_section_3

Grading Ulcer (dermatology)_section_4

Wagner's grading of ulcer follows: Ulcer (dermatology)_sentence_39

Ulcer (dermatology)_table_general_1

GradeUlcer (dermatology)_header_cell_1_0_0 DescriptionUlcer (dermatology)_header_cell_1_0_1
0Ulcer (dermatology)_cell_1_1_0 Pre-ulcerative lesion or healed ulcerUlcer (dermatology)_cell_1_1_1
1Ulcer (dermatology)_cell_1_2_0 Superficial ulcerUlcer (dermatology)_cell_1_2_1
2Ulcer (dermatology)_cell_1_3_0 Ulcer deeper to subcutaneous tissue exposing soft tissue or boneUlcer (dermatology)_cell_1_3_1
3Ulcer (dermatology)_cell_1_4_0 Abscess formation underneath, osteomyelitisUlcer (dermatology)_cell_1_4_1
4Ulcer (dermatology)_cell_1_5_0 Gangrene of part of tissues, limb or footUlcer (dermatology)_cell_1_5_1
5Ulcer (dermatology)_cell_1_6_0 Gangrene of entire one area or footUlcer (dermatology)_cell_1_6_1

Management Ulcer (dermatology)_section_5

Investigations Ulcer (dermatology)_section_6

Some of the investigations done for ulcer are: Ulcer (dermatology)_sentence_40

Ulcer (dermatology)_unordered_list_1

Treatment Ulcer (dermatology)_section_7

Skin ulcers may take a very long time to heal. Ulcer (dermatology)_sentence_41

Treatment is typically to avoid the ulcer getting infected, remove any excess discharge, maintain a moist wound environment, control the edema, and ease pain caused by nerve and tissue damage. Ulcer (dermatology)_sentence_42

Topical antibiotics are normally used to prevent the ulcer getting infected, and the wound or ulcer is usually kept clear of dead tissue through surgical debridement. Ulcer (dermatology)_sentence_43

Commonly, as a part of the treatment, patients are advised to change their lifestyle if possible and to change their diet. Ulcer (dermatology)_sentence_44

Improving the circulation is important in treating skin ulcers, and patients are consequently usually recommended to exercise, stop smoking, and lose weight. Ulcer (dermatology)_sentence_45

In recent years, advances have been made in accelerating healing of chronic wounds and ulcers. Ulcer (dermatology)_sentence_46

Chronic wounds produce fewer growth hormones than necessary for healing tissue, and healing may be accelerated by replacing or stimulating growth factors while controlling the formation of other substances that work against them. Ulcer (dermatology)_sentence_47

Leg ulcers can be prevented by using compression stockings to prevent blood pooling and back flow. Ulcer (dermatology)_sentence_48

It is likely that a person who has had a skin ulcer will have it again; use of compression stockings every day for at least 5 years after the skin ulcer has healed may help to prevent recurrence. Ulcer (dermatology)_sentence_49

There is limited evidence that negative pessure wound therapy may be effective in reducing the time to healing of leg ulcers. Ulcer (dermatology)_sentence_50

See also Ulcer (dermatology)_section_8

Ulcer (dermatology)_unordered_list_2


Credits to the contents of this page go to the authors of the corresponding Wikipedia page: en.wikipedia.org/wiki/Ulcer (dermatology).