As podiatrists we are used to dealing with ulcers on the feet. The most frequent being those due to the effects of diabetes, neuropathy, ischaemia and occasionally venous disease. In addition, there are many other causes of ulceration of the skin - many of these being rare. In the British Journal of Dermatology, an article has been published on inflammatory skin disorders that can lead to wounds on the skin (1).
Figure 1 Purpura of the lower legs (reproduced under CC licence 4.0) (1)
Inflammatory skin conditions are often complex and require specialist care. Such wounds are usually painful, necrotic and have livid inflammatory edges to them. Histologically, they are caused by inflammation within the superficial or deep blood vessels (vasculitis).
The article is useful in that it explains the features of these unusual lesions, frequently appearing first on the lower limb and spreading proximally. Systemic disease may underlie a proportion of these lesions, but vasculitis is responsible for about 5% of all skin wounds. Careful assessment is required along with an array of clinical and laboratory tests to uncover the cause, however in many cases this is unknown.
The full paper is well worth a read as it runs through the clinical findings, assessment, diagnosis and treatment of the many different types of vasculitis along with treatment. The paper is open access and free to view under the creative commons Licence (CC BY-NC-ND 4.0).
The full paper can be accessed for free here
Reference
1. Dissemond J, Romanelli M. Inflammatory skin diseases and wounds. Br J Dermatol. 2022; early view
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