Rare Differential Diagnoses in Venous Leg Ulcer

Chronic wounds have become a common reason for treatment in both inpatient and outpatient settings. Many patients are often referred to specialized care or wound centers after a therapy- refractory course. In Germany, the primary medical disciplines managing chronic wounds are general practitioners, dermatologists and surgeons. Current global literature offers few and sometimes contradictory data on the incidence and prevalence of various wound types. However, dermatological practices frequently encounter patients with venous leg ulcers (Ulcus cruris), which are descriptively wounds located in the lower leg area. These ulcers result from a diverse group of underlying conditions. For effective long-term therapy, it is crucial to fully diagnose and treat the underlying causes of the wounds. The recently published S3 guideline on the local therapy of hard-to-heal chronic wounds emphasizes the importance of medical history and response to previous treatments A vital component of the initial patient contact is a wound-specific medical history, which can provide clues about the causes of the wound. Numerous publications have shown that vascular diseases are responsible for over 50% of chronic lower leg ulcer cases. The most common is venous leg ulcer, accounting for 40-60% of cases depending on the patient population. This is followed by arterial leg ulcers (15-30%) and mixed venous-arterial ulcers. K & ouml;rber et al. highlighted rarer causes of leg ulcers in a survey of wound experts and data from over 31000 patients. These rarer causes include pyoderma gangrenosum, necrobiosis lipoidica, vasculitis, hypertensive leg ulcer (Martorell), neoplastic ulcers, livedoid vasculopathy, calciphylaxis, and drug-induced ulcers. Given the complex pathogenetic relationships, interdisciplinary collaboration in investigating wound causes is crucial. To enhance understanding and presentation of these rare causes, we will discuss the key details of these conditions. In dermatology, patients with rarer causes of chronic lower leg ulcers often present themselves. Depending on the literature, up to 25% of cases involve non-vascular lower leg ulcers.