Abstract
Background: An ulcer is a discontinuity of an epithelial surface. There is usually progressive destruction of surface tissue. Chronic ulceration of the lower legs is a relatively common condition amongst adults, one that causes pain and social distress. The prevalence of active leg ulceration has been found to be 0.15%. The common causes are venous disease, arterial disease and neuropathy. The prevalence of leg ulcers has considerable variation geographica1ly and within ethnic group. No adequate literature on prevalence and aetiopathogenesis of chronic leg ulcers in Eastern Indian population is present till date.
Objectives: To study the prevalence and aetiopathogenesis of chronic leg ulcers in Eastern Indian population.
Methods: A prospective study was carried out in Sri Rama Chandra Bhanja medical College, Cuttack in the year 2019. Detailed history and examination findings of 60 patients who had presented with chronic leg ulcers were studied.
Results: The incidence rate of chronic leg ulcers among patients presenting to OPD was 0.14%. Males in rural area had higher incidence with a peak in middle age group, i.e, 41-50 years. Most common aetiology was found to be leprosy (60%) followed by venous ulcer (16.6%) and diabetic ulcer (11.6%).
Conclusion: Incidence of chronic leg ulcers in Eastern Indian population is comparable to that of other literature available and leprosy is still a common cause of chronic leg ulcers unlike seen in studies from other regions.
Keywords: Chronic leg ulcers, Eastern India, aetiopathogenesis.
References
- Kahle, H. J. Hermanns, and G. Gallenkemper, “Evidence based treatment of chronic leg ulcers,” Deutsches Arzteblatt ¨ International, vol. 108, no. 14, pp. 231–237, 2011.
- B. van Gent, E. D. Wilschut, and C. Wittens, “Management of venous ulcer disease,” The British Medical Journal, vol. 341, no. 7782, pp. 1092–1096, 2010.
- V. Gonzalez-Consuegra and J. Verd ´ u, “Quality of life in ´ people with venous leg ulcers: an integrative review,” Journal of Advanced Nursing, vol. 67, no. 5, pp. 926–944, 2011.
- S. Sasanka, “Venous ulcers of the lower limb: where do we stand?” Indian Journal of Plastic Surgery, vol. 45, no. 2, pp. 266– 274, 2012.
- Amir, A. Liu, and A. L. S. Chang, “Stratification of highest risk patients with chronic skin ulcers in a Stanford retrospective cohort includes diabetes, need for systemic antibiotics, and albumin levels,” Ulcers, vol. 2012, Article ID 767861, 7 pages, 2012.
- Rayner, K. Carville, J. Keaton, J. Prentice, and X. N. Santamaria, “Leg ulcers: atypical presentations and associated comorbidities,” Wound Practice and Research, vol. 17, no. 4, pp. 168–185, 2009.
- F. Cheng, D. Sahu, F. Tsen et al., “A fragment of secreted Hsp90𝛼 carries properties that enable it to accelerate effectively both acute and diabetic wound healing in mice,” The Journal of Clinical Investigation, vol. 121, no. 11, pp. 4348–4361, 2011.
- A. Rahman, I. A. Adigun, and A. Fadeyi, “Epidemiology, etiology, and treatment of chronic leg ulcer: experience with sixty patients,” Annals of African Medicine, vol. 9, no. 1, pp. 1– 4, 2010.
- R. Mekkes, M. A. M. Loots, A. C. van der Wal, and J. D. Bos, “Causes, investigation and treatment of leg ulceration,” The British Journal of Dermatology, vol. 148, no. 3, pp. 388–401, 2003.
- F. O’Brien, P. A. Grace, I. J. Perry, and P. E. Burke, “Prevalence and aetiology of leg ulcers in Ireland,” Irish Journal of Medical Science, vol. 169, no. 2, pp. 110–112, 2000.
- Faria, L. Blanes, B. Hochman, M. M. Filho, and L. Ferreira, “Health-related quality of life, self-esteem, and functional status of patients with Leg ulcers,” Wounds, vol. 23, no. 1, pp. 4–10, 2011.
- K. Sen, G. M. Gordillo, S. Roy et al., “Human skin wounds: a major and snowballing threat to public health and the economy,” Wound Repair and Regeneration, vol. 17, no. 6, pp. 763–771, 2009.
- R. Baker and M. C. Stacey, “Epidemiology of chronic leg ulcers in Australia,” Australian and New Zealand Journal of Surgery, vol. 64, no. 4, pp. 258–261, 1994.
- Korber, J. Klode, S. Al-Benna et al., “Etiology of chronic leg ¨ ulcers in 31, 619 patients in Germany analyzed by an expert survey University Clinic,” Journal der Deutschen Dermatologischen Gesellschaft, vol. 9, no. 2, pp. 116–121, 2011.
- K. Shukla, M. A. Ansari, and S. K. Gupta, “Wound healing research: a perspective from India,” International Journal of Lower Extremity Wounds, vol. 4, no. 1, pp. 7–8, 2005.
- Fu, Z. Sheng, G. W. Cherry, and Q. Li, “Epidemiological study of chronic dermal ulcers in China,” Wound Repair and Regeneration, vol. 6, no. 1, pp. 21–27, 1998.
- Fu, “Skin ulcers in lower extremities: the epidemiology and management in China,” International Journal of Lower Extremity Wounds, vol. 4, no. 1, pp. 4–6, 2005.
- Jull, N. Walker, V. Parag, P. Molan, and A. Rodgers, “Venous ulcer management in New Zealand: usual care versus guideline recommendations,” New Zealand Medical Journal, vol. 122, no. 1295, pp. 9–18, 2009.
- Casey, “Causes and management of leg and foot ulcers,” Nursing Standard, vol. 18, no. 45, pp. 57–58, 2004.
- Gottrup and T. Karlsmark, “Leg ulcers: uncommon presentations,” Clinics in Dermatology, vol. 23, no. 6, pp. 601–611, 2005.
- K. Sarkar and S. Ballantyne, “Management of leg ulcers,” Postgraduate Medical Journal, vol. 76, no. 901, pp. 674–682, 2000.
- C. Moloney and P. Grace, “Understanding the underlying causes of chronic leg ulceration,” Journal of wound care, vol. 13, no. 6, pp. 215–218, 2004.
- J. M. London and R. Donnelly, “ABC of arterial and venous disease. Ulcerated lower limb,” The British Medical Journal, vol. 320, no. 7249, pp. 1589–1591, 2000.
- Adeyi, S. Muzerengi, and I. Gupta, “Leg ulcers in older people: a review of management,” The British Journal of Medical Practitioners, vol. 2, no. 3, pp. 21–28.
- Aydin, S. Shenbagamurthi, and H. Brem, “Lower extremity ulcers: venous, arterial, or diabetic?” Emergency Medicine, vol. 41, no. 8, pp. 18–24, 2009.
- Collins and S. Seraj, “Diagnosis and treatment of venous ulcers,” The American Family Physician, vol. 81, no. 8, pp. 989– 996, 2010.
- H. Meissner, G. Moneta, K. Burnand et al., “The haemodynamics and diagnosis of venous disease,” Journal of Vascular Surgery, vol. 46, no. 6, supplement, pp. S4–S24, 2007.
- E. Grey, K. G. Harding, and S. Enoch, “Venous and arterial leg ulcers,” The British Medical Journal, vol. 332, no. 7537, pp. 347– 350, 2006.
- Newton, “Leg ulcers: differences between venous and arterial,” Wounds Essentials, vol. 6, no. 1, pp. 20–28, 2011.
- Irving and S. Hargreaves, “Venous and arterial leg ulceration,” InnovAiT, vol. 2, pp. 415–422, 2009.
- Moffatt, “Leg ulcers,” in Vascular Disease, S. Murray, Ed., pp. 200–237, Whurr Publishers, London, UK, 2001.
- P. Pendse, “Understanding diabetic foot,” International Journal of Diabetes in Developing Countries, vol. 28, no. 5, pp. 519– 526, 2010.
- Clayton and T. A. Elasy, “A review of the pathophysiology, classification, and treatment of foot ulcers in diabetic patients,” Clinical Diabetes, vol. 27, no. 2, pp. 52–58, 2009.
- S. K. Ghauri and I. K. Nyamekye, “Leg ulceration: the importance of treating the underlying pathophysiology,” Phlebology, vol. 25, supplement 1, pp. 42–51, 2010.
- Dean, “Leg ulcers and management,” Australian Family Physicisian, vol. 35, no. 7, pp. 480–485, 2006.
- Burrows, “Leg ulcers,” Wound Care Canada, vol. 8, no. 2, pp. 16–18, 2008.
- R. Siddiqui and J. M. Bernstein, “Chronic wound infection: facts and controversies,” Clinics in Dermatology, vol. 28, no. 5, pp. 519–526, 2010.
- Han, J. M. Zenilman, J. H. Melendez et al., “The importance of a multi-faceted approach to characterizing the microbial flora of chronic wounds,” Wound Repair Regeneration, vol. 19, no. 5, pp. 532–541, 2011.
- V. Agale, D. R. Kulkarni, A. G. Valand, R. R. Zode, and S. Grover, “Marjolin’s ulcer—a diagnostic dilemma,” Journal of Association of Physicians of India, vol. 57, no. 8, pp. 593–594, 2009.
- Panuncialman, S. Hammerman, P. Carson, and V. Falanga, “Wound edge biopsy sites in chronic wounds heal rapidly and do not result in delayed overall healing of the wounds,” Wound Repair and Regeneration, vol. 18, no. 1, pp. 21–25, 2010.
- V. Singh, L. Subhashree, P. Milani, D. Gemmati, and P. Zamboni, “Interplay of iron metallobiology, metalloproteinases, and FXIII, and role of their gene variants in venous leg ulcer,” International Journal of Lower Extremity Wounds, vol. 9, no. 4, pp. 166–179, 2010.
- Vowden, “Arterial disease: medical and future perspectives,” in Proceedings of the WUWHS Congress, 2008.
- Banerjee, Y. C. Chan, and C. K. Sen, “Micro RNAs in skin and wound healing,” Physiological Genomics, vol. 43, no. 10, pp. 543– 556, 2011.
- R. Schneider, “Micro RNAs as novel players in skin development, homeostasis and disease,” The British Journal of Dermatology, vol. 166, no. 1, pp. 22–28, 2012.
- D. Widgerow, “Chronic wounds—is cellular “reception” at fault? Examining integrins and intracellular signalling,” International Wound Journal, vol. 10, no. 2, pp. 185–192, 2013.
- S. Kirsner, W. A. Marston, R. J. Snyder, T. D. Lee, and D. I. Cargill, “Spray-applied cell therapy with human allogeneic fibroblasts and keratinocytes for the treatment of chronic venous leg ulcers: a phase 2, multicentre, double-blind, randomized, placebo controlled trial,”The Lancet, vol. 380, no. 9846, pp. 977–985, 2012.
- W. Wong, B. Levi, J. Rajadas, M. T. Longaker, and G. C. Gurtner, “Stem cell niches for skin regeneration,” International Journal of Biomaterial, vol. 2012, Article ID 926059, 8 pages, 2012.
- A. C. Frade, J. C. Netto, F. G. Gomes, E. L. Mazzucato, and T. A. M. de Andrade, “Natual membrane dressing and hypersensitivity,” Anais Brasileiros de Dermatologia, vol. 86, no. 5, pp. 885–891, 2011.
- A. C. Frade, R. V. C. de Assis, J. C. Netto, T. A. M. de Andrade, and N. T. Foss, “The vegetal biomembrane in the healing of chronic venous ulcers,” Anais Brasileiros de Dermatologia, vol. 87, no. 1, pp. 45–51, 2012.
Corresponding Author
Dr Swapnarani Behera
Associate Professor, Department of Skin & Venereal Diseases, SCB MCH, Cuttack, India
DOI: https://dx.doi.org/10.18535/jmscr/v8i5.93
