Skin ulcers

What causes skin ulcers?

Skin ulcers usually develop when a wound fails to heal properly, often because of an underlying problem with your circulation, nerves, or ability to move around.

You're more likely to develop a skin ulcer if you have diabetes, smoke, are living with obesity, are underweight, or have limited mobility.

They can also be cause by an infection or a lack of the nutrients your skin needs to repair itself.

Are there different types of skin ulcers?

Skin ulcers are usually grouped by their underlying cause:

• Venous ulcers: The most common type, caused by poor circulation in the leg veins, which lets blood pool in your lower legs and puts pressure on your skin – these usually appear on the lower leg
• Arterial ulcers: Caused by poor blood flow through the arteries, meaning your skin and tissue do not get enough oxygen – often found on the feet, toes or outer ankle
• Neuropathic ulcers: Linked to nerve damage, most often from diabetes, which reduces feeling in your feet so that minor injuries go unnoticed and don't heal
• Pressure ulcers (bedsores): Caused by prolonged pressure on one area of skin, often from sitting or lying in the same position for a long time so are common in people with limited mobility
• Vasculitic, traumatic and malignant ulcers: Less common types, linked to inflammatory conditions, injury, or a skin tumour respectively.

How are skin ulcers diagnosed?

A doctor or nurse will usually examine the ulcer and the skin around it, and ask about your medical history, including any previous circulation problems, blood clots or injuries.

They'll often check the pulses in your foot and ankle, sometimes using a handheld device called a Doppler, to check how well blood is flowing through your arteries. This is an important step, because the main treatment for venous ulcers – compression bandaging – isn't safe to use if the blood flow through your arteries is poor.

If there's any doubt about the cause, or your circulation needs a closer look, you may be referred to a specialist for further tests or scans.

How are skin ulcers treated?

Treatment depends on the type of ulcer, but for venous leg ulcers, the most common type, it usually involves:

• Cleaning the wound and applying a dressing, changed 1 to 3 times a week
• Compression bandaging, applied by a nurse, to improve circulation in your leg and help the ulcer heal – this can be uncomfortable at first, but the pain usually eases as the ulcer starts to heal
• Keeping your leg raised whenever you can, ideally with your toes above your hip level, to reduce swelling
• Staying as active as possible, including regular walking and ankle exercises, to support circulation.

With appropriate treatment, most venous leg ulcers heal within 6 months. If your ulcer becomes infected, with increased pain, discharge or redness, you may need a short course of antibiotics, though these treat the infection rather than healing the ulcer itself.

For other types of skin ulcer, treatment focuses on the underlying cause, such as improving blood flow through your arteries, managing your blood sugar levels if you have diabetes, or relieving pressure on the affected area.

When should I see a doctor?

See a GP or practice nurse as soon as you notice a sore or wound on your leg or foot that hasn't healed within 2 weeks, as skin ulcers are unlikely to heal without treatment.

Contact your GP or leg ulcer specialist promptly if an existing ulcer becomes more painful, produces more discharge, develops redness spreading around it (which may be harder to see on brown or black skin), or if you start to feel generally unwell, as these can be signs of infection.