Differential diagnoses for ulcers or wounds

After taking a history, examining the patient and performing relevant investigations, it is essential to make an accurate diagnosis of the aetiology of the ulcer or wound. The diagnosis dictates subsequent management.

Common ulcers and wounds discussed in this guideline are:

• surgical wounds
• skin tears
• minor burns
• abrasions
• haematomas
• pressure injuries
• wounds on a high-risk foot
• leg ulcers.

When making a diagnosis, consider uncommon causes of ulcers, including vasculitis (see leukocytoclastic vasculitis, urticarial vasculitis), pyoderma gangrenosum, Mycobacterium ulcerans, malignancy, necrobiosis lipoidica, calciphylaxis, lymphoedema, radiation-induced ulcers, drugs (eg warfarin or hydroxycarbamide [hydroxyurea]—see Medications that inhibit wound healing), syphilitic ulcers (see Syphilis) or dermatitis artefacta.

Review the diagnosis and consider referral if the wound is not progressing as expected (eg a 25% reduction in wound size of a venous leg ulcer by 4 weeks). Also address factors affecting ulcer and wound healing.

Discuss the expected prognosis and possible complications with the patient. If the ulcer is not expected to heal, a palliative approach to wound management may be required (see Ulcers or wounds not expected to heal).