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Ulcus cruris

Leg ulcers

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Zusammenfassung

Der Unterschenkel ist ein Prädilektionsort für die Entwicklung eines Ulkus. Das kann verschiedene Ursachen haben, sodass eine sorgfältige Differenzialdiagnose notwendig ist, häufig auch mithilfe einer Biopsie. Mit Abstand am häufigsten ist das Ulcus cruris venosum bei chronischer venöser Insuffizienz, sei es als primär oder als postthrombotisches Syndrom. Seine typische Lokalisation ist am medialen Knöchel. Kompliziertere und schwieriger zu behandelnde Ulcera venöser Genese sind das arthrogene Stauungssyndrom mit der Extremvariante des Gamaschenulcus. Bei arterieller Minderperfusion bildet sich ein Ulcus cruris arteriosum heraus. Das Ulcus hypertonicum ist mit den klassischen Gefäßrisikofaktoren Hypertonus und Diabetes verknüpft und beruht auf einer Arteriolopathie. Für Diabetes typisch ist die Necrobiosis lipoidica. Wichtige Differenzialdiagnosen eines Beinulcus betreffen das Pyoderma gangraenosum und die Kalziphylaxie. Chronische Ulcera können maligne entarten und die primär maligne Genese eines Ulkus ist ebenso möglich.

Abstract

The lower leg is in particular prone to the development of ulceration. Many different causes may lead to ulceration. Thus, a thorough diagnosis is mandatory, and a biopsy is often required. By far the most common type is the classical venous ulcer due to chronic venous insufficiency, located at the medial ankle. A more complicated—and more difficult to treat—type of venous ulcer is arthrogenic congestion syndrome with its extreme variant of a “legging” ulcer. In cases with severe peripheral arterial disease, an arterial ulcer may develop. The hypertensive ulcer Martorell is associated with arterial hypertension and diabetes; the underlying pathology is occlusion of arteriolar vessels. A typical diabetic ulceration is the necrobiosis lipoidica. Important differential diagnoses of leg ulceration include pyoderma gangrenosum and the calciphylactic ulcer. Due to a long-standing course, an ulceration may turn malignant. Vice versa, ulceration may occur as sign of a primary malignant lesion.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. U. Wollina, L. Unger, C. Stelzner, J. Machetanz und S. Schellong geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

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Authors and Affiliations

  1. Klinik für Dermatologie und Allergologie, Krankenhaus Dresden-Friedrichstadt, Städtisches Klinikum, Akademisches Lehrkrankenhaus der TU Dresden, Friedrichstr. 41, 01067, Dresden, Deutschland

    U. Wollina

  2. Medizinische Klinik 1, Krankenhaus Dresden-Friedrichstadt, Dresden, Deutschland

    L. Unger

  3. Medizinische Klinik 2, Krankenhaus Dresden-Friedrichstadt, Dresden, Deutschland

    C. Stelzner & S. Schellong

  4. Klinik für Neurologie, Krankenhaus Dresden-Neustadt, Dresden, Deutschland

    J. Machetanz

Authors
  1. U. Wollina
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  2. L. Unger
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  3. C. Stelzner
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  4. J. Machetanz
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  5. S. Schellong
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Corresponding author

Correspondence to U. Wollina.

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Wollina, U., Unger, L., Stelzner, C. et al. Ulcus cruris. Internist 54, 1323–1329 (2013). https://doi.org/10.1007/s00108-013-3342-4

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  • DOI: https://doi.org/10.1007/s00108-013-3342-4

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