Venous leg ulcers: the initial stage, and how to treat, photos
Trophic ulcer appeared on the leg, is a dangerous sign that indicates a serious breach of lymph and blood circulation in the lower limbs. In addition to the aesthetic ugliness and pain, the disease may spread to large areas of the skin and cause life threatening complications. It is therefore important to distinguish venous leg ulcers from other skin diseases at an early stage.
What is a trophic ulcer?
Trophic ulcer — a violation of the integrity of the skin due to disturbed innervation or obstructed lymph flow and blood flow. Malnutrition of the tissues leads to a gradual withering away with the formation of nonhealing wounds. From other diseases, trophic ulcers features:
- long-term (up to 1 month or more) recurrent in nature;
- the spread of the lesion not only on the surface of the skin but also deeper tissue down to the bone;
- loss of ability to regenerate in the damaged area;
- healing occurs with the formation of rough scar.
Timely treatment of trophic ulcers lead to scarring. However, no patient is immune from recurrence of venous ulcerations on the feet in the future.
Causes of venous ulcers
Before to treat trophic ulcer, you need to find out the cause of a violation of trophism and innervation of the legs. Doctors distinguish several diseases of long duration which causes the formation of trophic ulcers on the legs. These include:
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- Chronic venous insufficiency — running varicose veins, thrombophlebitis. Usually, ulcers are formed in the lower third of the leg.
- Pathology of the arterial blood supply atherosclerosis, diabetes. Ulcers are formed on the plantar surface of the big toe, podbelceva cushions, heel and on the tops of the finger phalanges.
- The violation of innervation of tissue — injuries of the spine and head with prolonged immobilization, pathology of the peripheral nerves. Primarily affects areas of contact with the surface of the heel, the rear surface of the gastrocnemius muscle. From pressure ulcers, neurotrophic ulcers are characterized by a small outside area and a depth of damage (to the bone).
- Violation of capillary circulation — hypertension. Ulcerative process affects the outer surface of the middle part of the calf.
- Skin diseases — furunculosis, purulent or weeping eczema. In the nature of occurrence of pyogenic ulcers plays a major role to hygiene and low social level. Single or multiple lesions occur on the whole surface of the tibia.
Trophic ulcer on the leg also occurs when the following pathologies:
- Complicated syphilis.
- Common tuberculosis.
- Burns the limbs and frostbite.
- Diseases of the blood.
- The higher the dose of irradiation.
- Intoxication with arsenic, chromium.
Trophic ulcer: the initial stage
The possible development of trophic ulcers of is indicated by the following signs:
- burning of the skin, painful to the touch;
- swelling of the feet;
- obvious venous pattern on the lower extremities;
- cramping at night.
The appearance of these external changes, indicates malnutrition of the skin and high risk of development of ulcer-trophic pathology. Started at this stage, effective treatment of the causal disease will help to avoid the formation of ulcers.
The first symptoms sores
The duration of formation of trophic ulcers lasts from several hours to several weeks. It all depends on the degree of devascularization and the reactivity of the organism. Initial stage of formation of trophic ulcers is characterized by the following local changes:
- «lacquer» skin in the place of the future destruction of the skin becomes more dense and shiny, appears hyperpigmentation;
- the signs of inflammation — redness, cohesion of the upper layers of skin with a deeper, swelling (it’s impossible to take skin fold), pain, sensation of heat and burning causing itching;
- oozing — through «lacquer» skin begins to seep liquid (dew drops), wipes with antiseptic at this stage will help to avoid infection;
- whitish spots — necrosis of the skin, beginning tissue necrosis and the formation of a scab any touch leads to an open wound;
- weeping ulcer — cherry color open wounds, it affects only the top layers of the skin, initially, the area of the pathological focus usually does not exceed three square centimeters;
- often on the surface of wound develops infection of the ulcer is allocated purulent contents with an unpleasant odor.
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Characteristic features of development of various types of trophic ulcers:
- atherosclerotic ulcers are preceded by «intermittent claudication» (difficulty climbing stairs), constant coldness of feet, increased pain at night;
- venous ulcers, night cramps, swelling and heaviness of the feet, purple/purple spots along the veins;
- diabetic ulcers — the loss of sensitivity, night pain, no symptom «intermittent claudication», is rapidly developing a very deep wound of large area;
- neurotrophic ulcers — have the form of a deep crater;
- hypertensive ulcer (Martorell) is a very rare, slowly form a symmetrical seal on a red and blue background;
- pyogenic ulcer — shallow, have an oval shape.
The treatment of early stage sores
The sooner a full (local and systemic) treatment, the best results will be achieved, and the body will undergo to smaller risk. Shallow ulcerated skin defects are treated conservatively, surgical intervention in this case is inappropriate. How to treat sores, and how to apply the products — to decide the doctor-phlebologist. Independently conducted local treatment can result in healing a single ulcer, but does not exclude the appearance of new wounds. Only prescribed by a doctor local effects and systemic therapy of the underlying disease will prevent the deepening of the ulcer process and minimize the chances of recurrences. Local treatment:
- bandaging the affected limb with an elastic bandage;
- in the absence of an open wound surface — ointment that improve blood circulation (Rutin, Fenolip), vegetable gel Escin;
- treatment local anesthetics (Chlorhexidine, chamomile, Furatsilin) and anti-inflammatory ointments (Levomekol, Venugopal, Toxicol, Levosin) — daily loose bandage with the pre-treatment with hydrogen peroxide;
- diabetes — topical application of enzymatic means;
- agents that increase tissue regeneration — applies the ointment on venous ulcers Actovegin, Solcoseryl, Curiosin.
Local cure for the sores will only help in case if simultaneously with the treatment of wounds the therapy of the causal disease. Systemic medications for the treatment of trophic ulcers:
- pain management — drugs of NSAIDs (Ketoprofen, Diclofenac);
- reduce sensitisation — Suprastin, Tavegil;
- phlebotonics and angioprotectors — Ginkor Fort, Antistax, Detralex (the best cure for venous ulcers), Venoruton;
- antibiotics — if the infection of the wound and rapid development of inflammation;
- antiplatelet agents — Aspirin, Ipton, Clopidogrel, Chimes, Cardiomagnyl.
Trophic ulcer on the leg indicates that the patient should radically change their way of life. Should abandon bad habits, to eat rationally and to follow a special diet, to start tempering procedure and avoid immobility. All this combined with medicinal treatment will accelerate the healing and to avoid complications: erysipelas, sepsis, lymphangitis and gangrene.