Juvenile leg ulceration in beta-thalassemia major and intermedia

A series of 12 patients with beta-thalassemia who developed juvenile leg ulcers is described. The trophic skin changes and leg ulcers occurred after the age of 15 years. Usually the ulcer occurred after trauma over the predisposed medial aspect of the leg. In four out of seven females, the trophic changes deteriorated during or following pregnancy. The development of trophic changes and subsequent leg ulcers is not related to the severity of the anemia or to the patients' transfusion requirements, but may be related to high fetal hemoglobin concentration. The ulcers are slow to heal and tend to recur. Multiple skin-grafting operations are required in order to achieve satisfactory coverage of the ulcers. Since tissue hypoxia may be the underlying pathophysiology, the use of topical hyperbaric oxygen chamber may be beneficial in the treatment of thalassemic leg ulcers.