Table 1. Differential diagnosis for lower extremity ulcerations 35 .
| Differential diagnosis for leg ulcers | |
|---|---|
| Vascular disease • Venous: postthrombotic syndrome, varicose veins, chronic venous reflux • Arterial: peripheral arterial occlusive disease, hypertension, arteriovenous fistulas, arterial thrombosis, embolism, dysplasia, thromboangiitis obliterans, aneurysm • Lymphatic: lymphedema • Microangiopathy: diabetes, livedoid vasculopathy • Vasculitis • Hypertensive arteriolopathy |
• Neuropathic • Peripheral neuropathy: diabetes, alcohol, medication, heredity • Central neuropathy: tabes dorsalis, myelodysplasia, syringomyelia, spina bifida, poliomyelitis, multiple sclerosis |
| Metabolic • Diabetes mellitus, gout, prolidase deficiency, Gaucher disease, amyloidosis, calciphylaxis, porphyria, hyperhomocysteinemia |
• Hematologic • Sickle cell anemia, thalassemia, polycythemia vera, leukemia, thrombocythemia, lymphoma, myeloplastic disorders, disorders of coagulation factors (factors I–XIII), coagulation inhibitors (antithrombin III, activated protein C resistance, protein C and S), or fibrinolysis factors (tissue plasminogen activator inhibitor, plasmin) |
| Autoimmune • Rheumatoid arthritis, leukocytoclastic vasculitis, polyarteritis nodosa, Wegener granulomatosis, Churg–Strauss syndrome, systemic lupus erythematosus, Sjogren syndrome, scleroderma, Behcet disease, cryoglobulinemia |
• Exogenous • Heat, cold pressure, ionizing radiation, chemical, allergens, trauma |
| Neoplasia • Basal cell carcinoma, squamous cell carcinoma (Marjolin ulcer), malignant melanoma, angiosarcoma, cutaneous lymphoma, papillomatosis cutis carcinoids, keratoacanthoma |
• Medication • Hydroxyurea, leflunomide, methotrexate, halogens, coumarin, vaccinations, ergotamine, infiltration cytostatic agents |
| Infection • Bacterial: furuncles, ecthyma, mycobacterioses, syphilis, erysipelas, anthrax, diphtheria, chronic vegetative pyodermia, tropical ulcer • Viral: herpes, variola virus, cytomegaly • Fungal: sporotrichosis, histoplasmosis, blastomycosis, coccidioidomycosis • Protozoal: leishmaniasis |
• Genetic defect • Klinefelter syndrome, Felty syndrome, TAP1 mutation, leukocyte adhesion deficiency, inherited hypercoagulable factors |
| Skin disorder • Pyoderma gangrenosum, necrobiosis lipoidica, sarcoidosis, perforating dermatosis, Langerhans cell histiocytosis, papulosis maligna atrophicans, bullous skin diseases |