Ulcers

Dr Philip Marazzi outlines some commonly presented ulcers

Diabetic ulcer

This woman with insulin-dependent diabetes developed a painless ulcer on her foot following minor trauma. It took many months but eventually healed. She has subsequently had a number of other foot problems, presumably caused by a combination of her diabetic neuropathy and vascular disease. Although still in her early forties, she had many years when she refused to manage her diabetes properly. She is now paying the price.

Pressure sore

This elderly lady with severe multiple sclerosis developed this deep sacral pressure sore very rapidly. Her immobility coupled with continence problems has aggravated the situation. The district nurses have tried various packs and dressings to encourage healing; as yet unsuccessfully. It is having a serious effect on her general condition.

Infected eczema


This young woman with chronic eczema had been neglecting her skin and developed this area of infected eczema on her leg. Topical steroids and antibiotics helped it to heal. The cause remains uncertain. There was a history of psychological problems in this patient but it is not known whether this was relevant.

Bite allergy


This woman was bitten by a mosquito and developed this allergic reaction which ulcerated. Like many patients, she assumed the wound was infected and attended the surgery requesting a course of antibiotics. They were not necessary and the bite healed quickly.

Basal cell carcinoma


This ulcerated lesion turned out to be a basal cell carcinoma. It had been growing for some time and had been ignored by the patient. It was excised successfully. It shows the characteristic rolled edge which is often seen in these tumours.

Pyoderma gangrenosum


This elderly man developed pyoderma gangrenosum. He was diabetic and had undergone renal transplantation. The lesion started as a blister, which did not heal. A range of topical agents was tried and had no apparent effect. He had two similar lesions which did not heal for several months. He never fully recovered from the operation, and eventually he died from an unrelated infection.

Congestive cardiac failure


This 89-year-old woman had cardiac failure. It was difficult to control her symptoms and she developed increasing oedema. The skin was so swollen and tight that it began to break down as shown. It took a long time to heal these lesions as she was immobile. The ulcers did eventually heal associated with some improvement in her cardiac function.

Wound infection


This 23-year-old man presented with syncopal episodes. All initial investigations, including a 24-hour Holter monitor were negative. He then had an implantable loop recorder placed under his chest. Following this he developed a wound infection, which opened up revealing the device beneath the skin. It healed with antibiotics but unfortunately failed to provide the diagnosis.

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