Leg Ulcers

What causes them?
Leg ulcers are areas of skin, usually on the lower legs that have broken down. They can take a long time to heal.

The common cause is poor circulation in the lower legs. This becomes quite common as you get older. When the blood flow up the leg veins, back to the heart is sluggish, this causes a build up of pressure in the veins. Blood and fluid leak out of the veins into the surrounding tissues and cause an irritation which results in eczema (inflammation of the skin) and sometimes ulceration.

Poor circulation down your legs, in your arteries is another cause of leg ulcers and in some people poor circulation in both the arteries and veins is to blame.

Other causes of leg ulcers :

Trauma - cuts, particularly over the shin bone in older people can take a long tim eto heal and sometimes form an ulcer.
Vasculitis - inflammation of the blood vessels can be seen in a number of diseases including rheumatoid arthritis. This can cause leg ulcers.
Other skin conditions - there are other, rare inflammatory causes of leg ulcers.

What treatments are there?
Various creams and dressings can be used but the most effective treatment for ulcers caused by poor circulation in the veins is compression. This can be either in the form of support stockings or if the problem is more severe then a four layer compression bandage may be used. The District Nurse normally changes this every few days. The elastic layer in the bandaging helps squeeze the blood back up the legs. Before this form of treatment is used a doppler test is normally performed to check that the blood flow down the legs through the arteries is satisfactory.

If there is a problem with the arteries then surgery to improve the blood flow may be required.

Ulcers associated with vasculitic diseases are usually helped by treating the disease itself.

What problems may I develop with my leg ulcers?

Eczema
Eczema can be found with venous leg ulcers. It can be treated with moisturisers, steroid creams and paste bandages. This treatment may need to continue after the ulcers have healed.

Infection
Ulcers can become infected. Offensive smelling discharge and weeping from the ulcers are usually signs of this. Swabs are usually taken to decide if antibiotic treatment is required. Soaking the leg in potassium permanganate solution can help.

Will my ulcers ever heal?
Ulcers often do heal but make take months or even longer to do so. It is important to treat any associated factors which may make an ulcer worse, or delay healing such as anaemia, diabetes, or obesity. Gentle exercise is important to help healing, and it is important to address lifestyle since a health diet and stopping smoking will help lessen ulceration.