Differential diagnosis of chronic leg ulcers

Background: Chronic leg ulcers are nonhealing wounds on the distal aspects of the leg. Chronic venous insufficiency occurs when the venous system of the legs becomes inefficient and is a price we pay for our upright posture. The majority of chronic leg ulcers are caused by venous disease, but occasionally ulcers are associated with arterial problems or vessel inflammation (vasculitis). Objective: To describe the varying dermatoses found in patients with chronic leg ulcers. Study design: Literature search and personal experience of differential diagnoses associated with chronic leg ulcers. Setting: Patients with chronic leg ulcers attending the Phlebology Clinic of the University Dermatology Department in Zagreb. Methods: Determination of causes of leg ulcers through medical history, physical examination and laboratory investigations. Results: Authors' recommendations for a general approach to the differential diagnosis of chronic leg ulcers. Conclusion: Leg ulcers associated with chronic venous insufficiency occur in 1% of the population in developed countries and are found in 5% of those aged 80 years or more. The correct diagnosis of the cause of leg ulceration is important as up to 20% are not of venous origin.