Hi,

Thank you for the query,

There is a possibility that we are dealing with either a Arterial ulcer or a Venous ulcer here.Other bleak possibility is of Pyoderma gangrenosa.

Before I can come to any conclusion I would like to know few things here:
1) What is the exact position of the ulcer on the leg(medial or lateral)
2)Do you also have a varicose veins.
3) When do you get maximum pain over it ,is it while keeping the leg down or when kept elevated.
4) How did the ulcer start (the evolution of ulcer).
5) Did you have any itching on the leg before you developed the ulcer.
6) Are you suffering with any diagnosed medical conditions?(say diabetes).
7) Has it healed any time ?

You can even consider sending me a close up picture of the lesion which would help me further. You can send it at YYYY@YYYY and kindly mention "ATTN Dr.Bharat Chawda" as a subject. Also please reply to this mail saying that you have enclosed a picture.

Kindly reply me with the answers & pictures as this would help me in suggesting you better.

Awaiting your reply.

Regards,
Dr.Bharat chawda

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Hi!Judy,

Thank you for the reply and the picture,

By the look of the ulcer and its location it seems to be a venous non-healing ulcer of leg.But without proper investigations we cannot rule other possibilities esp arterial ulcer.
Its very important to diagnose which type of ulcer we are dealing with , as it would help in treating as well.

Usually venous ulcers are not painful,but some patients may have pain .They are located around the ankle and have well defined borders.The reason for venous ulcer is incompetent valves of vessels which lead to venous congestion.Venous ulcers may be associate with dilatation of vessels of the calf muscles(varicose veins).

Arterial ulcers are usually over dorsal aspect of foot and they are very painful.
This is due to improper blood circulation over the area.These are usually associated with diabetes , cholesterol imbalance etc.

To diagnose this one needs to take blood pressure over the ankles and the arm both.The ratio of both these is called Ankle Brachial Pressure Index (ABPI).This would help to rule out the arterial cause of ulcer.
Doppler study is also important .
In complicated cases you may need to have a scan (ultrasound, CT or MRI) to produce a detailed map of the blood circulation in your leg.

So its very important that you consult a specialist who is frequently dealing with leg ulcers ,as your treatment would greatly depend upon the diagnosis.

As far as steroids which was given to you is concerned ,it should not be the cause of this problem ,since it was taken for a short duration(even though it should have been tapered).

Treatment starts with proper compression bandage and dressing of the wound.There are certain non-surgical methods of improving the circulations like
use of low-intensity ultrasonic stimulation of venous ulcers .

Leg elevation is important in case of venous ulcers.
Medicines like Pentoxifylline improves blood circulation and you may be offered this drug to promote healing of the ulcer.
A skin graft may be advised for a large ulcer, or for one that does not heal well.
Smoking should be avoided as it hampers in healing of wound.
Surgery can be advised for varicose veins .

I hope this would help you understand your condition better and your line of treatment as would be advised by your doctor.

I will be available for follow up query if any.

Regards,
Dr.Bharat chawda

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