Monday, January 5, 2015
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.
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.