The skin on the lower leg is dry, red and itchy, later develop brown pigmentation, weeping eczema and skin hardening. It creates an open space that just does not heal. Nearly a million people in Germany suffer from leg ulcers, mainly on the basis of a venous disease.
Occurrence of the ulcus cruris
The ulcus cruris occurs more in old age and has serious economic consequences. It is estimated that nearly 15% of adult Germans have chronic venous disease - the most common cause of lower leg ulcers. The cost of treatment for venous leg ulcers alone in Germany is estimated at about € 1.5 billion or 1-2% of the health insurance budget. And as the population ages, they will tend to increase over the next few years. Therefore, the effective prevention and therapy are important.
How does a leg ulcer develop?
Badly healing, deep wounds on lower legs are almost always caused by vascular disease, not - as one might at first glance - by a skin disease. The ulcer arises on the bottom of a deficiency of the tissue.
In more than 70% of cases a venous disorder (ulcus cruris venosum) is underlying, in about 8% an arterial disease (ulcus cruris arteriosum), 14% are due to simultaneous changes in the venous and arterial system (ulcus cruris mixtum):
- Venous leg ulcer (Ulcus cruris venosum): In a venous insufficiency or after a thrombosis, the blood accumulates back into the legs, which initially leads to an accumulation of water (edema), later in addition to a hardening of the skin and connective tissue. The backflow continues into the capillaries, the finest blood vessels between arteries and veins. As a result, the blood stream slows down or stops completely, so that no longer sufficient oxygen and nutrients can be released from the blood into the surrounding tissue. Aggravating the mass transfer tissue swelling is added by the edema, which are compressed from the outside of the vessels.
- Arterial leg ulcer (ulcus cruris arteriosum): In arterial vascular disease, arteriosclerosis causes narrowing of the arteries until complete occlusion of the arteries. This concerns first the small and smallest vessels. Here, too, results in a shortage of the surrounding tissue with the possible result of an ulcer.
- Other forms: Rarely, the leg ulcer is due to a limited joint function, such as the upper ankle (arthralgia congestion syndrome), infections (Ulcus infectiosum), blood disorders (ulcus haematopoeticum), cancer (ulcus neoplasticum) or by other diseases (eg ulcerative colitis).