Condition Location Characteristics and Causes

Venous ulcer Distal leg, especially

above medial mellolus • Develops in regions of skin changes due to chronic venous
disease and local venous hypertension
• Typically wet (ie, wound drainage) rather than dry lesion

Distal small arterial Toes, foot, leg • Diabetic microangiopathy

occlusion • End-stage renal disease
(microangiopathy) • Thromboangiitis obliterans (Buerger’s)
• Sickle-cell anemia
• Vasculitis (eg, Churg-Strauss, Henoch-Schonlein purpura,
leukocytoclastic vasculitis, microscopic polyangiitis, polyarteritis
nodosa)
• Scleroderma
• Cryoagglutination
• Embolic (eg, cholesterol emboli, thromboemboli, endocarditis)
• Thrombotic (eg, antiphospholipid antibody syndrome,
Sneddon’s syndrome, warfarin skin necrosis, disseminated
intravascular coagulation, livedoid vasculitis, protein C or S
deficiency, prolonged vasospasm)

Local injury Toes, foot, leg • Trauma , Insect or animal bite, Burn

Medication related Toes, foot, leg • Drug reactions (eg, erythema multiforme)
• Medication direct toxicity (eg, doxorubicin, hydroxyurea,)

Neuropathic Pressure zones of foot • Hyperkeratosis surrounds the ulcer

• Diabetes mellitus with peripheral neuropathy
• Peripheral neuropathy without diabetes mellitus
• Leprosy

Autoimmune injury Toes, foot, leg • With blisters (eg, pemphigoid, pemphigus, epidermolysis
bullosa)
• Without blisters (eg, dermatomyositis, lupus, scleroderma)

Infection Toes, foot, leg • Bacterial (eg, pseudomonas, necrotizing streptococcus)

• Fungal (eg, blastomycosis, Madura foot, chromomycosis)
• Mycobacterial
• Parasitic (eg, Chagas, leishmaniasis)
• Viral (eg, herpes)

Malignancy Toes, foot, leg • Primary skin malignancy

• Metastatic malignancy
• Malignant transformation of ulcer

Inflammatory Toes, foot, leg • Necrobiosis lipoidica

• Pyoderma gangrenosum
• Granuloma annulare