Varicose ulcers
Diagnosis is
not usually difficult. Gummatous
ulcers
and
Bazin's disease, are the
most likely conditions
to cause difficulty. The
presence
of varicose veins, oedema, purple
discolouration, pigmentation and
thickening of the skin,
ulceration
on
the inner side of the
lower third of the
leg and extreme chronicity are in
favour of varicose ulcer.
Syphilitic ulcers may occur
in patients who already
have
varicose dermatitis, but they
are likely to be on
the outer side of
the leg, to begin as
swellings
which break down in the
centre, to have a
" punched out"
appearance, a yellow sloughy
base and to be
arranged
in arcs of circles.
The Wassermann reaction will
probably be positive but
a
patient with a varicose
ulcer may also have
syphilis and so give a
positive Wassermann.
Treatment
Local-varicose eczema is treated in the same way as other eczematous eruptions,the condition responding well under compression bandaging. varicose panniculitis requires no local application, but responds well to surgery, compression or both. When the condition is painful, however, an initial period in bed may be necessary. Varicose ulcers should be treated locally with bland applications, such as wet gauze compresses of half strength Eusol or equal parts of Eusol and liquid paraffin.Occasionally, when secondary infection is severe, especially if with Ps. pyocyanea, the appropriate antibiotic may be applied. Complete occlusion for a week at a time with an occlusive bandage such as
Viscopaste is sometimes the best treatment. Large or painful ulcers may necessitate a short period in bed. Occasionally, skin grafting is required.
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