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Cardio Exam

Vascular Skin Changes of the Leg

July 1st, 2020


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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