Rare aetiologies of leg ulcers: a prospective analysis

As treatment guidelines differ based on the causal effects of hard-to-heal (chronic) leg ulcers, correct diagnosis is essential for the best therapeutic outcomes. The aim of the study was to ascertain the prevalence of patients displaying atypical and uncommon manifestations of hard-to-heal leg ulcers and to explore the corresponding diagnostic challenges.

This was a prospective analysis of the aetiologies of hard-to-heal leg ulcers in patients hospitalised at the University Clinic of Dermatology, Venereology and Allergology, Poland, between 2015-2022. Data were coded into a database. Patients had an initial diagnosis of L97 according to the International Classification of Disease (ICD)-10-a non-pressure hard-to-heal ulcer of the lower limb, not elsewhere classified. Ulcer duration was >6 weeks, as this is the most used definition of a hard-to-heal wound.

Of the 327 patients who took part in the study, 119 had a diagnosis other than vascular. Patients were aged between 18-97 (mean 67.5) years; 163 were male and 164 were female. In patients with ulcers of rare aetiology, the most common was pyoderma gangrenosum, followed by vasculitis, then neoplasms or complication after antineoplastic treatment.

It is important to be acquainted with rare aetiologies of leg ulcers for best therapeutic outcome, as atypical ulcers may require different treatment modalities.