[Uncommon causes of leg ulcers: investigative approach and therapeutics]

Chronic wounds of the lower limbs are a major public healthcare problem affecting 1 percent of the adult population and 3 to 5 percent of people older than 65 years. These numbers are rising in the western population as a result of increased life expectancy and increased risk factors for atherosclerotic occlusion, such as smoking, obesity, and diabetes mellitus. This very debilitating condition, which reduces significantly the quality of life, causes social discomfort and generates considerable cost, not only to the patient but also to the society. Treating chronic leg ulcers is always a challenge. Over the last years, the treatment of this condition has been given more attention because of the frequent ineffectiveness of the methods used, the awareness of the psychological and social impact, and the recognition of the risks of malignancy in these wounds. Determining the etiology is an essential factor for directed and more effective wound care. Although 90 percent of ulcers are of vascular origin, the list of other possible causes responsible for the other 10 percent is extremely long. In this review, the authors focus on the differential diagnosis of chronic leg ulcers and the impact of directed treatment in the prognosis of this condition.