- Calciphylaxis
- Cutaneous Coagulopathies
- Diabetic Foot Ulcers
- Pressure Ulcers
- Stasis Dermatitis
- Vasculitis
- Venous Leg Ulcers
Stasis Dermatitis is related to leaking varicose veins in legs which cause swelling and rash from superficial or deep leg veins. It is usually treated with leg elevation and compression, topical steroids and if not, can lead to ulcers and scarring of the legs. Sometimes a vascular surgeon can help by ablation (destroying) veins with a minor outpatient surgery.
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Venous Leg Ulcer are related to chronic swelling related to varicose veins. Treatment is a combination of specialized dressings, leg elevation, infection control and compression wrap therapies in most patients. In persistent lesions, various advanced biologic dressings and skin grafts may also be used.
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Diabetic Foot Ulcers are pressure related ulcers in diabetics where altered sensation and foot shape results in chronic friction and wounds. Treatments are related to removal of pressure, improving blood supply and removal of unhealthy tissues. Unresponsive diabetic foot ulcers are the main precursor to limb amputation in diabetics.
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Pressure Ulcers are wounds due to pressure over bony areas like the buttocks, hips and back in persons who have limited movement or spend prolonged times in bed. Treatments including a variety of advanced wound dressings, effective pressure reduction are key.
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Vasculitis is a group of diseases all related to an immune attack on the blood vessels. Smaller vessels, especially on lower legs, are common and present with tender purplish bumps which can ulcerate. Small vessel disease can occasionally affect the kidneys (blood in urine), gi tract (blood in stool, abdominal pain), lungs (shortness of breath or coughing up blood) or other organs rarely. Larger vessel disease can present with larger tender nodules or open sores on limbs, fingers, toes, etc Treatments are based on the severity and type of vasculitis and range from local topical agents to compression hose to systemic immune suppressors. Associated diseases can be infectious, autoimmune, medication reactions or underlying cancers.
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Cutaneous Coagulopathies are a variety of diseases that result in tiny clots or occlusions of skin blood vessels resulting in crusts and sores on the legs. Often quite painful, they can be due to immune reactions or genetic diseases and treatment is variable, based on the underlying cause.
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Pyoderma Gangrenosum is an autoimmune process that results in painful, rapidly growing ulcerations of the skin from minimal trauma. It can be associated with inflammatory bowel diseases, lupus, rheumatoid arthritis, blood protein abnormalities or underlying cancers. About 50% of cases have no related diseases. Treatments include good wound care, cautious removal of dead tissue without sharp debridement that damages the wound margins and aggravates the disease. Immune suppression therapies from topical steroids and topical tacrolimus, to intralesional steroid injections, to systemic agents like prednisone, cyclosporine, mycophenolate or others may be required. Workup initially involves labs to evaluate for underlying diseases, sometimes tissue biopsies to help diagnose and cultures to rule out infections.
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Calciphylaxis (calcific uremic arteriolopathy) is a condition caused by deposition of calcium in the small skin blood which can lead to ischemia, painful ulceration, and large areas of dead tissue in fleshy areas of the trunk and extremities. The most common form is related to advanced kidney disease, while rarer forms can be medication related.
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