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WHAT IT IS: "A break in an epithelial surface". There are a large number of causes for skin ulcers including venous, arterial, neuropathic/diabetic, pressure, vasculitis, malignancy (e.g. squamous cell carcinoma) and infectious (e.g. Buruli ulcer or cutaneous leishmaniasis).


HOW IT IS IDENTIFIED: Ulcers present as a break or sore in the skin. It is important to establish any history of diabetes, trauma, travel or preceding insect bite. Patients may report a wound that isn't healing. Presence of pain and claudication are vital clues. Examination should detail the site, size, and colour. Presence of pus and/or surrounding erythema may indicate an infected ulcer. Venous ulcers are typically shallow and have an irregular border. Look for a sloughy base (granulating tissue) and signs of venous insufficiency in the legs (venous eczema, haemosiderin deposits, lipodermatosclerosis). Arterial ulcers are typically round and "punched out" (deep with a well-defined border), look for a necrotic base. People with diabetes are at higher risk of developing foot ulcers, ensure you remove their socks and check pressure areas (do not forget to inspect the toes). Source: A Handbook Mind The Map, Clinical signs in Black and Brown Skin.  Mukwende M, Tamony P,  Turner M  

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