Management of leg ulcers

This article aims at describing a methodical approach to leg ulcer management in the primary care setting.
The key information that you want to elucidate from history and examination will be recapped.
The three main types of ulcers – venous, arterial and diabetic – will then be examined in more detail and the management of each will be discussed. Care of people with skin problems requires GPs to:
– Ensure that skin problems are not inappropriately dismissed as trivial or unimportant by healthcare professionals;
– Empower patients with chronic skin problems, including managing the effects of disfigurement;
– Demonstrate appropriate history-taking for patients with skin problems, including past personal history, family history, chemical contacts, occupation and drug usage;
– Value the role of other members of the primary healthcare team (e.g. specialist health visitors for eczema and wet wrapping, district nurses nurse practitioners for leg ulcers and wound management);
– Recognise the huge prevalence of skin disease in the community and its impact on patient’s lives and healthcare resources;
– Understand and implement the key national guidelines that influence healthcare provision for skin problems.
An ulcer can simply be defined as erosion in an epithelial surface. Most commonly, they are an external manifestation of an underlying pathological process. Ulcers in the lower limb are often caused by venous stasis, arterial insufficiency and diabetes.
It is vital to identify the underlying process as this will guide subsequent treatment.