Ulcer

Definition;
An ulcer is a break in the continuity of the epithelium (Skin and mucous
membrane) characterized by progressive destruction of the surface
epithelium and a granulating base

Parts of ulcer

1. Floor – It is the exposed surface of the ulcer

2. Edge – it is the junction between the normal and ulcerated
epithelium
3. Margin – It is the surface between the edge and floor of the ulcer
4. Base – It is the area on which the ulcer rest

Classification
A. Ulcer may be classified as
a. non-specific
i. Peptic
ii. Pressure sores (decubitus ulcers) and ischaemic
ulcers
iii. Gravitational ulcers – venous insufficiency
iv. Secondary infective – wound infection and abscess
drainage
v. Traumatic ulcers
vi. Neuropathic ulcers – diabetes, tabes dorsalis, leprosy
vii. Iatrogenic – intravenous fluid extravasation
viii. Dermatitis artefacta – self-mutilation
ix. Aphthous
b. Specific - primary infective –
i. herpes simplex,
ii. tuberculosis,
iii. fungal,
iv. syphilis
c. malignant
i. Gastrointestinal tract
ii. Skin

B. Aetiological
a. Traumatic
i. Mechanical – irregular tooth or denture
ii. Chemical – Acid or alkali
iii. Thermal – Burn
iv. Electrical – shock
v. Radiation – radiation necrosis of skin
b. Inflammatory
 i. Single organism – M. tuberculosis and T. pallidum
( chancre)
ii. More than one organism – Meleney’s ulcer
c. Vascular
i. Arterial – which produce undemutrition – Ischemic
necrosis
ii. Venous – like varicose vein – varicose ulcer
iii. Lymphatic – like filarial lymphangitis – filarial ulcer
d. Neoplastic
i. Primary malignancy – SCC, BCC, Malignant
melanoma
ii. Secondary metastatic malignancy , which may
ulcerative
e. Miscellaneous
i. Trophic ulcer – peripheral neuritis
ii. Metabolic causes – Diabetic foot ulcer
C. Clinical classification
a. Acute (spreading) ulcer
b. Healing ulcer
c. Chronic ulcer
Feature Acute Healing Chronic
History
Duration Short Weeks Months
Pain Marked Mild Absent
Fever Marked Absent May be present
Loss of function Severe Little Variable
Physical sign
Inspection
Shape Variable Regular Variable
Profuse, Thin serous Seropurulent
Discharge offensive Absent May be present
Floor Slough Absent Bright red Unhealthy &
Absent pale
Granulation
Edge Ragged Sloping Variable
Surrounding Erythromatous Normal Pigmented
skin
Palpation
Tenderness Present Absent Minimal
Edge Ragged, Normal, thin Thick indurated
inflamed
Bleeding on Present Present Absent if not
touch malignant
Induration & fixity Absent Absent Present
to surrounding
structure
Regional lymph Enlarged & Not palpable Enlarged,
node tender nontender