Eine chronische Wunde am Unterschenkel ist in der dermatologischen Ambulanz ein häufig
gesehenes Krankheitsbild. Dennoch stellen Diagnostik und Therapie eine Herausforderung
dar, denn es sind nicht nur die vaskulären, sondern auch die selteneren Differenzialdiagnosen,
die es frühzeitig zu erkennen und kausal zu therapieren gilt, wobei der Dermatologe
oft erster konsiliarischer Ansprechpartner anderer Fachdisziplinen ist.
Abstract
Diagnosis of a chronic leg ulcer should be performed early and in a structured manner
by means of anamnesis, clinical examination, bacteriological smear and vascular diagnostics.
About 10 – 20 % of the leg ulcers are caused by rare diseases. Ulcerating skin tumours
can be misinterpreted as vascular wounds. This might lead to a deterioration in the
overall prognosis of the patient. In the presence of rheumatoid arthritis or other
underlying inflammatory diseases, a pyoderma gangrenosum should be considered. A positive
travel history to endemic areas may be indicative of leishmaniasis if the ulceration
is found in an unusual localization or if the patient is young. An interdisciplinary
case discussion in case of complicated or unclear wounds is recommended for the development
of an individual treatment concept.
Schlüsselwörter
Ulcus cruris - Differenzialdiagnostik - Gefäßerkrankungen - Pyoderma gangraenosum
- Interdisziplinarität
Key words
leg ulcer - differential diagnosis - vascular disease - pyoderma gangrenosum - interdisciplinarity
