Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jan 29;11(1):62-78.
doi: 10.3390/dermatopathology11010007.

The Histopathology of Leg Ulcers

Amun Georg Hofmann  1 , Julia Deinsberger  1 , André Oszwald  2 , Benedikt Weber  1
Affiliations
Review

The Histopathology of Leg Ulcers

Amun Georg Hofmann et al. Dermatopathology (Basel). .

Abstract

Ulcerations of the lower extremities are a frequently encountered problem in clinical practice and are of significant interest in public health due to the high prevalence of underlying pathologies, including chronic venous disease, diabetes and peripheral arterial occlusive disease. However, leg ulcers can also present as signs and symptoms of various rare diseases and even as an adverse reaction to drugs. In such cases, correct diagnosis ultimately relies on histopathological examination. Apart from the macroscopic presentation, patient history and anatomic location, which are sometimes indicative, most ulcers have very distinct histopathological features. These features are found in different layers of the skin or even associated vessels. In this narrative review, we discuss and highlight the histopathological differences of several types of leg ulcers that can contribute to efficient and accurate diagnosis.

Keywords: histopathology; leg ulcer; ulceration; wounds.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Leg ulcer caused by chronic venous disease. (A) Overview, red arrow = beginning of ulceration, black asterisk = inflammatory infiltrates, blue asterisk = erythrocyte extravasate, black circle = diffuse edema. (B) Magnification, black arrows = hemosiderophages, black rectangle = fibrin cuff.
Figure 2
Figure 2
Ulcer caused by livedoid vasculopathy. (A) Overview, black rectangle = epidermal atrophy, white rectangle = diffuse leukocyte infiltration. (B) Magnification, black arrows = leukocytes.
Figure 3
Figure 3
Arteriolosclerotic ulcer of Martorell. (A) Black rectangles = calcification. (B) Black rectangle = subintimal hyalinization.
Figure 4
Figure 4
Calciphylaxis. (A) Overview, black rectangles = calcifications in different layers of the skin. (B) Magnification, black rectangle = vessel-associated calcifications, black arrows = extra-arterial calcium deposits.
Figure 5
Figure 5
Pyoderma gangrenosum. (A) Overview, black rectangle = massive leukocyte infiltration. (B) Magnification, yellow asterisks = leukocyte infiltration, black rectangles = perivascular lymphocytic infiltrates with associated fibrin thrombi suggestive of secondary vasculitis.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Pannier F., Rabe E. Differential diagnosis of leg ulcers. Phlebology. 2013;28((Suppl. S1)):55–60. doi: 10.1177/0268355513477066. - DOI - PubMed
    1. Mekkes J., Loots M.A.M., Van Der Wal A.C., Bos J.D. Causes, investigation and treatment of leg ulceration. Br. J. Dermatol. 2003;148:388–401. doi: 10.1046/j.1365-2133.2003.05222.x. - DOI - PubMed
    1. Agale S.V. Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management. Ulcers. 2013;2013:1–9. doi: 10.1155/2013/413604. - DOI
    1. Lautenschlager S., Eichmann A. Differential diagnosis of leg ulcers. Curr. Probl. Dermatol. 1999;27:259–270. doi: 10.1159/000060619. - DOI - PubMed
    1. Sen C.K., Gordillo G.M., Roy S., Kirsner R., Lambert L., Hunt T.K., Gottrup F., Gurtner G.C., Longaker M.T. Human skin wounds: A major and snowballing threat to public health and the economy. Wound Repair Regen. 2009;17:763–771. doi: 10.1111/j.1524-475X.2009.00543.x. - DOI - PMC - PubMed

Grants and funding

This research received no external funding.

LinkOut - more resources

-