• A photograph of a chronic skin ulcer.

• Notice that the epithelium has been completely denuded, leaving behind an obvious area of hyperemic subcutaneous granulation tissue.

• This is apparently a chronic ulcer of the skin as indicated by the induration and hyperpigmentation of the area around it.

•A number of conditions can result in ulcers of the skin.

•Acute ulcers may result from a variety of causes, including infections, neoplasms, chemical or thermal injury.

•Chronic ulcers result from neoplasms, vascular injury, debilitation, and neurological conditions where the patient is unaware of injury to the affected part.

•An ulcer is an area of loss of the epithelium, with acute or chronic inflammation in the underlying connective tissue.

•Ulcers may be acute or chronic, depending upon the nature of the inflammatory process.

•In acute ulcer, the epithelium is lost and there is edema, congestion, and polymorphonuclear leukocyte infiltration in the underlying tissue.

•In a chronic ulcer, there may be exuberant proliferation of young capillaries with plump fibroblasts and chronic inflammatory cells including lymphocytes and macrophages (granulation tissue).

•Common

•Depending upon the cause, acute ulcers are self-limiting with appropriate treatment.

•Chronic ulcers, especially if large, need replacement of the ulcer bed and skin grafting to provide fresh epithelium to grow over the affected area.

•Grossly, there is a breach in the epidermis with exposure of the underlying tissue.

•Granular, reddish granulation tissue is seen in the chronic, healing ulcer.

•Acute ulcers show evidence of acute inflammation.

•Chronic ulcers have granulation tissue at the base.

•Robbins and Cotran: Pathologic Basis of Disease, 7th ed., 2005, pp. 77-8.

• Current literature from PubMed at National Library of Medicine