Venous ulcers start as a dark or red area that can become thickened, dry, itchy, or tingly. Without treatment, an open wound (ulcer) may form.
This article reviews the symptoms, causes, diagnosis, and treatment of venous ulcers.
Symptoms
An early sign of a venous ulcer is the darkening or reddening of an area of skin on the leg. It is most often over a bony area like the ankle. The skin may also become thick, dry, itchy, or tingly. Without treatment, an ulcer, which is an open, shallow wound, may form.
Venous ulcers often cause a dull ache or pain in the legs and swelling that subsides with elevation. If an ulcer develops, it usually has the following characteristics:
Shallow soreUneven shapeWell defined bordersRed at the base and may be covered with yellow tissueSurrounding skin is often tight, shiny, warm, and discolored
Causes
Venous ulcers are the most common type of leg ulcer and 1%–3% of the U.S. population has one. The primary risk factors are older age (over 55), obesity, previous leg injuries, deep venous thrombosis, and inflamed veins.
Foul odor from the ulcer Pus coming from the wound Increased drainage Drainage that is yellow or cloudy Bleeding from the wound Redness, swelling, or warmth around the ulcer Fever or chills Increased pain
Risk of developing venous ulcers is increased by:
Blood clotting disorders Pregnancy Obesity Family history of varicose veins (enlarged, dark colored veins with a cord-like appearance) Chronic venous insufficiency History of pulmonary embolism (clot or blockage in a lung artery) Smoking Excessive alcohol use Poor nutrition Excessively long periods of inactivity or standing Recent operative (surgery) procedures Lower-extremity skeletal or joint disease
Diagnosis
Diagnosis begins with a physical examination and taking a medical history. A healthcare provider may diagnose a venous ulcer if the wound has an irregular shape, is shallow, has well-defined borders, and is over a bony area.
A provider will also look for other signs of venous disease, including varicose veins, swelling in the legs or ankles, decreased lower extremity circulation, and venous dermatitis (a skin condition caused by insufficient blood flow to the area).
While venous ulcers are the most common type of ulcer on the legs, your provider will also rule out other causes. These include complications from diabetes (diabetic pheripheral neuropathy) or skin cancer.
Your healthcare provider may also use an imaging test called an ultrasound (noninvasive imaging test). A biopsy (removing a small tissue sample for analysis in a lab) may be needed if the wound is not healing or looks atypical.
Treatment
Treating a venous ulcer requires the use of various methods to improve circulation. Treatment starts out conservatively and will likely include compression therapy and elevating your legs.
Compression Therapy
Compression therapy is the standard treatment for venous ulcers, It improves chronic venous insufficiency and reduces pain and swelling. Compression therapy includes the following:
Elastic bandages: These bandages conform to the shape and size of the leg. They can be worn during rest and while walking. Typically, they are changed about once a week. Inelastic compression wraps: These are used during ambulation (walking or activity). They are not intended for nonambulatory people (people who have difficulty walking or cannot walk). They are often infused with zinc oxide due to its skin-soothing effects. Compression stockings: Compression stockings are used for either healing or prevention. They are removed at night and can be washed. They are usually replaced every six months because the washing slowly causes them to lose compression.
Dressings
Sterile dressings are recommended when the wound is open. The type of dressing varies based on the location, size, presence of infection, cost, allergies, and comfort. Wound care is constantly changing and improving. Your provider may refer you to a wound care specialist so they can treat you with the most up-to-date treatment methods.
There is also evidence that being active may help prevent venous ulcers from occurring. This is especially true when exercise is done in tandem with compression therapy.
Debridement
If venous ulcers become infected or resist healing for longer than six months, more aggressive treatments such as debridement (removing the damaged tissue) may be considered. Debridement is used to speed up wound healing through the removal of dead or infected tissue.
Types of debridement include:
SurgicalEnzymatic (topical, on the skin application)Larval (maggots)Mechanical (wet-to-dry dressings, pressurized water therapy, irrigation)
Leg Elevation
Keeping your legs elevated helps increase blood flood flow and reduce venous pressure. One study has shown that leg elevation used with compression for at least one hour a day and six days per week helped with venous ulcer healing.
Surgery
Surgery for venous ulcers may include vein ablation to correct damaged valves in the vein, reduce varicose veins, increase healing, and help prevent recurrence. Vein ablation cauterizes (burns) and closes off veins. It is minimally invasive. It is done under a local anesthetic (skin-numbing injection). The healthcare provider inserts a small catheter in the vein and uses laser therapy to help heal the vein.
Skin grafting is reserved for wounds that aren’t healing well or are large (greater than 25 centimeters). This procedure involves taking healthy skin from one area of a person’s body and covering a damaged area.
Medications
Sometimes medications are required to treat venous ulcers. The type of medication depends on the underlying problem. For example, antibiotics may be used for an infection, while other medications may be used to improve vein health or function. The following are medications that your provider may prescribe to help treat venous ulcers:
Aspirin is sometimes used as a therapy, but the evidence that it works is inconsistent. Trental (pentoxifylline) increases blood flow and helps with circulation. Statins, such as Zocor (simvastatin), are typically prescribed for high cholesterol but have properties that can help with venous ulcer healing. Antibiotics are a class of drugs that can help heal infected venous ulcers.
Summary
Venous ulcers are shallow wounds or sores on the leg. They typically form over a bony area such as the ankle and are caused by circulation (blood flow) problems. These sores start as a dark or red area and may become thick, dry, and itchy or tingly. Without treatment, an open wound or ulcer may form.
Risk increases with age, pregnancy, chronic venous insufficiency, smoking, a family history of varicose veins, and more. Diagnosis usually involves a history and physical and ruling out other conditions such as diabetic complications (neuropathy) or skin cancer. In some cases, your provider may order an ultrasound or biopsy.
The first line of treatment is usually compression therapy and leg elevation. If the wound is infected, not healing, or large, it may require more advanced treatment including medications, debridement, or surgery.
A Word From Verywell
Many people feel anxious or worried when they get a venous ulcer. While venous ulcers can be uncomfortable, they are highly treatable. Contact your healthcare provider if you have symtpoms since early treatment can prevent venous ulcers from getting worse. In the meantime, you can help take control of your health by making lifesyle changes. This includes eating a healthy diet, exercising, and quitting smoking (if you are a smoker).
