A Challenging Diagnosis of Leg Ulcer

Abstract

Ischaemic ulcers of the lower limb can have several aethiopathological mechanisms. For instance, the uncommon Martorell hypertensive leg ulcer is an infrequent complication of long-term uncontrolled arterial hypertension and is largely ignored and underdiagnosed. The typical ulcer is on the lower leg, is extremely painful and presents in female patients over 60 years of age with cardiovascular risk factors, mainly severe arterial hypertension. The diagnosis is histological, with obliteration of the arterioles by arteriolosclerosis. In these cases, antihypertensive medication is the standard treatment. We describe the case of an African-American female patient with long-term hypertension who presented with a very painful leg ulcer. The diagnosis was complicated by the coexistence of more common causes of ulcer. Despite analgesic medicines, pain relief was only obtained with control of hypertension. A definite diagnosis was made following biopsy.In describing this diagnosis of an ischaemic leg ulcer, we highlight the need to consider the skin as a target organ of arterial hypertension.LEARNING POINTSMartorell hypertensive leg ulcer is an underdiagnosed cutaneous lesion arising from long-term uncontrolled hypertension.The diagnosis is confirmed by histopathology.Standard treatment is adequate control of blood pressure.

Application of Topical Hyperbaric Oxygen Therapy and Medical Active Dressings in the Treatment of Arterial Leg Ulcers—A Pilot Study

“…The Incidence of arterial ulcers of the lower limbs is estimated in Europe and the United States at 500–1000 new cases per million inhabitants per year, and their incidence is 1.3–2.3% of the population [ 5 ]. Due to the aging of societies, more frequent lower limb ischemia, and the application of increasingly accurate diagnostic methods, the frequency of ulceration detection has increased [ 5 , 6 , 7 ]. The burden on the health service for the treatment of lower limb ulcers, including patients with peripheral arterial disease, is significant.…”

Differentiating Arteriolosclerotic Ulcers of Martorell from Other Types of Leg Ulcers Based on Vascular Histomorphology

“…Therefore, histological assessment of peri-ulcerative skin biopsies has gained increasing interest over the years. Although several authors have advocated for a bioptic assessment in suspected cases ( 7 , 13 , 15 ), others question its value ( 16 , 17 ). Since the first report on histopathology in ASUM by Faber & Hines ( 18 ), several different “typical” histological findings in patients with ASUM have been reported.…”