Trophic ulcers: symptoms

Trophic ulcers have characteristic symptoms. They are manifested by the appearance of a long-term non-healing wound on the skin. Symptoms depend on the etiology of the disease against which the trophic ulcer arose. The variety of reasons for the development of the syndrome requires the doctor to carefully collect anamnesis, scrupulous physical examination of all organs and systems of the patient, and involve specialists in related specialties (dermatologist, rheumatologist, oncologist, hematologist, etc.). In addition to local skin-trophic changes, general symptoms characteristic of the underlying disease are almost always present to one degree or another. Thus, pyogenic trophic ulcers are characterized by signs of a systemic inflammatory reaction, with arterial ulcers - symptoms of intermittent claudication, with venous ulcers - symptoms of chronic venous insufficiency.

All skin trophic ulcers, although they have common patterns of development and healing, symptoms are heterogeneous in their origin, size, localization, depth, features of the clinical course of the wound process, etc. These are dynamically changing formations that are subject to certain structural changes in the period from the moment of their formation to healing. At the first stages, the wound cavity is filled with wound contents (transudate or exudate, detritus), then granulation tissue and finally epithelium as a result of defect healing.

The signs usually occur in several stages. Initially, a pathological lesion with impaired cutaneous microcirculation is formed on the skin. Then, with minimal trauma, and in some cases spontaneously, the skin defect itself occurs, characterized by the development of inflammation, necrosis of the skin and underlying tissues. Many venous, ischemic and some other trophic ulcers are formed in a similar way. Pyogenic trophic ulcers are characterized by the formation of a papule, infiltrate, then a pustule, ecthyma or abscess and only then an ulcerative defect. In ulcerative-necrotic vasculitis, gangrenous pyoderma, multiple polymorphic primary skin elements initially appear in the form of spots, erythema, hemorrhage, blisters with a cyanotic color of the surrounding skin. All these pathomorphological changes in the skin and symptoms correspond to stage I of the wound process. The duration of this stage varies, depends on the etiology of the disease and can last from 2 weeks, as with some pyogenic ulcerative defects, to several months and even years, as with such defects as decubital, venous and ischemic trophic ulcers.

With a favorable course of the underlying disease and wound process, necrotic masses are rejected, acute inflammation is stopped with the growth of granulation tissue of varying degrees of maturity, either independently or as a result of treatment. These symptoms correspond to stage II of the wound process. If optimal conditions for healing are provided, the trophic ulcer ends with epithelialization of the wound and reorganization of the scar, which corresponds to stage III of the wound process.