Venous Leg Ulcer: Or something else? Differential Diagnosis

Blood, hematopoietic organs – immune system (D50-D90).

  • Werlhof’s disease (idiopathic thrombocytopenic purpura, ITP) – autoantibody-mediated disorder of platelets (thrombocytes) with spontaneous small-spot bleeding.
  • Polycythaemia vera – abnormal proliferation of blood cells (particularly affected are: especially erythrocytes/red blood cells, to a lesser extent also platelets (blood platelets) and leukocytes/white blood cells); prickly itching after contact with water (aquagenic pruritus).
  • Sickle cell anemia (med.: drepanocytosis; also sickle cell anemia, sickle cell anemia) – genetic disease with autosomal recessive inheritance affecting erythrocytes (red blood cells); it belongs to the group of hemoglobinopathies (disorders of hemoglobin; formation of an irregular hemoglobin called sickle cell hemoglobin, HbS).
  • Sideroachrestic anemia – special form of aplastic anemia (anemia).
  • Spherocytosis (spherocytosis).
  • Thalassemia – autosomal recessive hereditary synthesis disorder of the alpha or beta chains of the protein portion (globin) in hemoglobin (hemoglobinopathy/diseases resulting from impaired formation of hemoglobin).
    • Α-Thalassemia (HbH disease, hydrops fetalis/generalized fluid accumulation); incidence: mostly in Southeast Asians.
    • Β-Thalassemia: most common monogenetic disorder worldwide; incidence: People from Mediterranean countries, Middle East, Afghanistan, India and Southeast Asia.
  • Thrombocythemia – strong multiplication of blood platelets.

Endocrine, nutritional and metabolic diseases (E00-E90).

  • Amyloidosis – extracellular (“outside the cell”) deposits of amyloids (degradation-resistant proteins) that can lead to cardiomyopathy (heart muscle disease), neuropathy (peripheral nervous system disease), and hepatomegaly (liver enlargement), among other conditions.
  • Diabetes mellitus (diabetes) with wound healing disorders (about 5% of all ulcers).
  • Gout

Skin and subcutaneous (L00-L99)

  • Decubital ulcers (pressure ulcers) during immobilization.

Cardiovascular system (I00-I99)

  • Angiodysplasia (vascular malformations).
  • Lymphatic drainage disorders
  • Ulcus cruris arteriosum (lower leg ulcer caused by peripheral arterial occlusive disease (pAVK); about 10-15% of all ulcers.
  • Ulcus cruris hypertonicum (Martorell’s syndrome) – lower leg ulcer, which is caused by inferior supply of the tissue with blood due to angiolitis (vascular inflammation).
  • Ulcus cruris mixtum – lower leg ulcer, which arises from a combination of arterial and venous circulatory disturbance.
  • Ulcus cruris varicosum (lower leg ulcer, which is caused by varicose veins; about 60-80% of all ulcers).
  • Vasculitides (vascular inflammation) as in the context of a periarteriitis nodosa or pyoderma gangraenosum (painful disease of the skin, in which it comes over a large area, usually in one place, to an ulceration or ulceration (ulceration or ulcer) and to a gangrene (tissue death due to a reduction in blood flow or other damage).
  • Vasculopathy (vascular disease) as in:
    • Cholesterol emboli
    • Calciphylaxis (synonyms: uremic calcifying arteriolopathy (UCA): metastatic calcification; it is a particularly severe and painful course of renal osteodystrophy (renal damage-related bone loss); pathological (abnormal) deposits of calcium and phosphate salts in the blood vessel walls and subcutaneous fat tissue are characteristic.
    • Necrobiosis lipoidica (synonym: necrobiosis lipoidica; it is a rare granulomatous inflammation of the middle dermis (dermis) with accumulation of lipids, often associated with diabetes mellitus; the inflammation leads to necrosis (death) of the skin and usually occurs on the lower leg extensor sides)

Infectious and parasitic diseases (A00-B99).

  • AIDS
  • Skin infections, unspecified (e.g., following primary herpes zoster/shingles).
  • Tuberculosis

Musculoskeletal system and connective tissue (M00-M99)

  • Rheumatoid arthritis – chronic inflammatory joint disease.
  • Vasculitis – immune-reactive triggered inflammation of blood vessels.

Neoplasms – tumor diseases (C00-D48)

Psyche – nervous system (F00-F99; G00-G99).

  • Munchausen syndrome – psychiatric clinical picture in which illnesses are feigned in order to achieve a secondary gain in illness

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99)

  • Gangrene – local tissue death; a distinction is made between dry and wet gangrene.
  • Edema (water retention)

Medication

  • Therapy with hydroxyurea (synonyms: Hydroxycarbamide (INN), hydroxyurea; cytostatic drug used to treat, in particular, hematopoietic malignancies (leukemias, myeloproliferative neoplasms (MPN) (formerly: chronic myeloproliferative diseases (CMPE))).

Further

  • Chemical or physical damage, unspecified.
  • Chronic infections, e.g., after insect bite
  • Drug abuse