Vascular Skin Changes of the Leg
On this page:Pallor of the Lower LimbLower Limb ErythemaVenous Skin ChangesArterial Skin ChangesNeuropathic Ulcers
Overview
- Skin changes and overall poor skin condition of the lower limb may occur due to soft tissue disease; arterial, venous or lymphatic insufficiency; loss of afferent nerve supply or simply poor self-care.
Pallor of the Lower Limb
Look For
- Loss of colour in one or both lower limbs.
Causes of Lower Limb Pallor
- Peripheral vascular disease
- Compartment syndrome
- Low cardiac output, due to cardiac disease
- Peripheral shutdown, due to increased sympathetic activity
Lower Limb Erythema
Look For
- Redness - unilateral, bilateral, localised or diffuse.
Causes of Lower Limb Erythema
- Dermatosis
- Infection - cellulitis, lymphangitis, necrotising fasciitis
- Vascular - deep venous thrombosis, superficial thrombophlebitis, venous insufficiency
- Lipodermatosclerosis (fibrosis of subcutaneous fat)
- Lymphoedema
Venous Skin Changes
Look For
- Oedema
- Venous eczema
- Hyperpigmentation
- White scar tissue (atrophie blanche)
- Induration - fibrosis of subcutaneous fat (lipodermatosclerosis)
- Ulceration - red, painless ulcers with moderate exudate, most commonly over the gait area (from mid-calf to 1cm below the malleoli)
Significance
- Venous insufficiency.
Causes of Venous Skin Changes
- Venous insufficiency
- Venous outflow obstruction
- Calf-muscle pump failure - obesity, immobility
Arterial Skin Changes
Look For
- Absent pedal pulses
- Thin / shiny skin
- Cool skin
- Hair loss
- Ulceration - white, painful ulcers with blanched surrounding tissue; may become black with necrosis
Significance
- Partial or complete arterial occlusion.
Causes of Arterial Skin Changes
- Atherosclerosis
- Diabetes
- Thromboangiitis
- Vasculitis
Neuropathic Ulcers
- Neuropathic ulcers occur due any cause of sensory loss to the foot, resulting in greater likelihood of damage and unawareness of injury.
Look For
- Deep ulcers surrounded by callus, most commonly on weight bearing areas such as the sole of the foot. Associated with diminished sensation of the foot and normal pedal pulses.
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