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The high prevalence of chronic venous disease in the population of developed countries, with the presence of varicose veins in 30 to 50% of the French population, is strongly correlated with environmental factors but also with hereditary factors. The physiopathological mechanisms of chronic venous disease are still poorly understood. Genetics could therefore be essential to understanding the disease, and especially its severity in some patients, including those who evolve to trophic disorders. Venous disease could also benefit from the latest technological advances, including theGWAS, which with the huge amount of data analyzed could lead us to unsuspected culprit. [ABSTRACT FROM AUTHOR]

A leg ulcer is mostly of vascular origin, complicating a venous, arterial or microcirculatory underlying pathology. Diagnosis of vascular origin is based on a simple clinical examination. This takes into account the aspect of the ulcer and the surrounding tissues, its localization and vascularization of the limb. [ABSTRACT FROM AUTHOR]

The erysipelas is a bacterial infection most frequently due to (85% of cases) streptococcus β-hemolytic of group A (SGA), resulting in nonnecrotizing dermo-hypodermitis. Many factors may play a role in its occurrence such as general factors: diabetes, immunosuppression, chemotherapy, radiotherapy as well as locoregional ports of entry such as leg ulcer, an insect bite, intertrigo. The occurrence of erysipelas associated with recurrent squamous cell carcinoma after radiochemotherapy is exceptional, requiring early treatment of dermo-hypodermitis as well as suitable and multidisciplinary management of the carcinoma. The mechanism of the occurrence of erysipelas after radiotherapy coincides with its pathophysiology. Indeed, this therapeutic component, which is very used to treat squamous cell carcinoma, alters lymphatic drainage resulting, very gradually, in lymph fibrosis thus weakening the defense mechanism. Its association with alteration of cellular immunity, also favored by radiotherapy and chemotherapy, can cause the occurrence of erysipelas in these patients. We report the case of a 50-year old female patient with a 1-year history of squamous cell carcinoma of the right labium majus treatment with radiochemotherapy with remission. Eight months later, the patient had recurrence. Evolution was marked by the appearance of a painful hot erythematous plaque on the right thigh suggesting erysipelas, confirmed by laboratory tests which showed an infection. The patient was put on antibiotic therapy with good improvement and then referred to the Department of Oncology for recurrence management. [ABSTRACT FROM AUTHOR]

Abstract: A 72-year-old diabetic woman was referred with a painful chronic leg ulcer associated with venous and arterial insufficiency. She then developed a polymorphous skin infection due to Pseudomonas aeruginosa, with ecthyma gangrenosum, subcutaneous abscess and panniculitis of the homolateral inferior limb, without general sepsis. Although P. aeruginosa infection may induce polymorphous skin lesions, they are most often observed in immunocompromised patients following septicaemia. [ABSTRACT FROM AUTHOR]

Background: Drug addiction causes chronic wounds (CW) responsible for severe complications. Very few studies are available on this topic. The aim of our study was to describe the demographic, clinical and etiological characteristics as well as the course of CW in drug addicts., Patients and Methods: This was a retrospective and prospective multicenter study including all drug addicts with CW., Results: We included 58 patients (17 prospectively), 84.5% of whom were male, of median age 43 years, presenting multiple CW as a result of intravenous (78.2%), inhaled (41.1%) and/or snorted (20%) drug abuse. Addiction to opioids (68.4%), cocaine (47.4%) and/or cannabis (40.4%) was ended and/or treated through substitution in 79.3% of patients. CW were fibrinous and necrotic (42.9 to 53.6%), recurrent (54.2%), and in some cases had been present for more than 1 year (61.5%). Intravenous drug addiction was associated with large, fibrinous, ulcers in a setting of venous and lymphatic insufficiency (74%). Only 23% of these wounds involved the upper limbs. Necrotic ulcers associated with clinical arteriopathy were described mainly with inhaled addiction. Abscesses (50%) and erysipelas (29.3%) were the most common cutaneous complications. After 3 months, 50% of CW were improved and 29.2% of patients were lost to follow-up., Discussion: Drug abuse-related CW occurred preferentially in young men with history of intravenous abuse. For the most part, CW were seen on the legs and were associated with venous and lymphatic insufficiency, and the resulting major risk for cutaneous infection increased morbidity and mortality in this population in whom medical follow-up is inherently complicated., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: Certain anticancer drugs are known to induce leg ulcers, mainly chemotherapy agents such as hydroxyurea. We report 2 cases of leg ulcers in cancer patients treated with the tyrosine kinase inhibitors, sunitinib and nilotinib, and we discuss the role of these treatments in the pathogenesis of leg ulcers., Patients and Methods: Case 1. A 62-year-old patient on sunitinib for intrahepatic cholangiocarcinoma developed a lesion on her right foot. The vascular evaluation was negative. After progressive worsening, sunitinib was stopped and healing was observed within a few months. Case 2. A 83-year-old patient had been treated for chronic myeloid leukemia since 2005. Nilotinib was introduced in 2009. Peripheral arterial revascularization was required in May 2013. A few months later, worsening was noted with the onset of ulceration and necrosis of the third toe. Further revascularisation surgery was performed, and nilotinib was suspended and antiplatelets introduced. Healing occurred a few months later., Discussion: Many skin reactions have been described in patients on nilotinib and sunitinib, but few publications report the development of de novo ulcers in patients without risk factors. The pathophysiology of the development of ulcers in patients receiving tyrosine kinase inhibitors is not clear, and probably involves several mechanisms of action. The increasing use of this type of treatment could lead to an upsurge in the incidence of vascular complications., Conclusion: We report two cases of leg ulcers developing in patients on tyrosine kinase inhibitors and raise the question of causal implication of these treatments in the pathogenesis of ulcers., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Hypertensive leg ulcers (HLU) are a form of necrotic leg ulcer. Their physiopathology is not well known and in these patients, no venous or arterial insufficiency is detected. The primary objective of this study was to evaluate the association between HLU severity and the presence or absence of concomitant vitamin K antagonist (VKA) medication. We furthermore aimed to describe the epidemiology of this entity and the prevalence of thrombophilia factors in this population., Patients and Methods: This was a retrospective study in 54 patients hospitalized in the dermatology department of Reims University Hospital between 01/01/2007 and 31/12/2013: 23 patients were included in the "without VKA" group, and 30 were included in the "with VKA" group. Clinical and laboratory data were collected., Results: The average HLU surface was higher in the "with VKA" group i.e. 35.00cm 2 (min: 3.0; max: 220.0) versus 23.00cm 2 (min: 5.0; max: 300.0) (P=0.05). No significant difference was found in terms of time to healing, mean hospitalization duration, HLU treatment by skin grafting, or time to recurrence after healing. Mean patient age was 74.2±9.3 years; 100% of patients had arterial hypertension, 50.9% had diabetes, and 20.8% were active smokers. Abnormal but non-significant values for thrombophilia factors were observed., Conclusion: Our study shows no obvious differences between patients with HLU with or without VKA medication. A prospective, comparative study is necessary to further evaluate this hypothesis, with particular emphasis on routine thrombophilia factor analysis., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Chronic vascular wounds are often painful. Pain can develop whatever the cause of the ulceration. It is well known during wound care but can occur at any time. The pain is often a complex phenomenon involving nociceptive pain, neuropathic pain, anxiety and emotional suffering, all directly related to the chronic disease. Care for the patient suffering from pain must take into consideration all of these aspects of the disease. The therapeutic strategy should rely on the use of different pharmacological agents, well-adapted local care using the different available analgesic tools and include psycho-affective care., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

The prevalence of leg ulcers, which are most commonly caused by venous insufficiency, is high in Europe. Current treatments are fairly unsatisfactory, with long healing times in many cases, as well as a high risk of relapse. Over the last 15 years, improved understanding of the cellular and molecular mechanisms at work in delayed wound healing has contributed to the development of cellular therapy in this field. The use of keratinocytes or cultured fibroblasts, whether autogenic or allogenic, has been of little value in terms of either healing times or rates of complete healing. For the moment, there are very few allogenic skin substitutes available; they are expensive and have been insufficiently studied in the indication of leg ulcers. Pluripotent mesenchymal adult stem cells have proved capable of accelerating wound healing in animal models and their study in chronic wounds in humans is currently awaited., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background: Herein we report a case of phlegmasia cerulea dolens, a form of venous thrombosis complicated by arterial ischaemia., Patients and Methods: A 69-year-old man presented a bilateral trophic condition of the lower limbs that had appeared 3 weeks earlier. The patient had a history of metastatic urothelial bladder carcinoma and arteritis. Clinical examination revealed right leg ulcers with massive bilateral oedema of the lower limbs, cyanosis and local ischaemia. Doppler ultrasound revealed bilateral and proximal deep vein thrombosis (sural and superficial femoral veins of the right leg; sural and iliac veins of the left leg) without any distal arterial flow. We concluded on a diagnosis of bilateral phlegmasia cerulea dolens., Discussion: Phlegmasia cerulea dolens is a particular type of deep venous thrombosis in which a proximal venous thrombus is combined with arterial ischaemic signs due to brutal and massive oedema and slowing down of arterial flow. In most cases, the lower limbs are involved, with malignancy being the most common cause. It should be suspected in the presence of the classical triad of "pain, oedema and cyanosis", with confirmation by Doppler ultrasound. There is no general consensus regarding standard management. Traditionally, systemic anticoagulation has been the mainstay of treatment for this condition. Endovascular surgery may be a possibility in some cases. Prompt diagnosis and rapid treatment initiation are paramount in order to improve the prognosis of this severe condition with ominous prospects., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)

Objectives: To present the clinical aspects of leg ulcers among patients with sickle-cell disease, propose a protocol for treating them, and identify risk factors for their onset in our patients., Patients and Methods: This 5-year retrospective descriptive study (2007-2012) includes six adolescents homozygous (SS) for this disease who had at least one leg ulcer during the study period., Results: Our population was aged 16-20 years and comprised 4 young men and 2 young women. Signs at diagnosis included pallor (100%), jaundice (100%), splenomegaly (80%), and fever (70%). Painful crises most often involved a vaso-occlusive crisis (42%), followed by a splenic sequestration crisis (27%), a hemolytic crisis (18%), and erythroblastopenia (14%)., Conclusion: Leg ulcers are a complication of sickle cell disease and cause esthetic, psychological, and economic problems. Prevention involves patient education to prevent the occurrence and recurrence of these ulcers.

Introduction: Venous leg ulceration is associated with pain and poor health-related quality of life (HRQL). The purpose of this study was to identify demographic and clinical characteristics associated with pain and decreased HRQL in patients with active venous ulcers., Methods: Baseline data were combined from two trials that took place between 2001 and 2007 (n = 564). Pain was measured using the Numeric Pain Scale (NPS), and HRQL was measured using the Medical Outcomes Survey 12-item Short Form (SF-12), which generates a Physical (PCS) and Mental Component Summary (MCS). Analyses included logistic and linear regression (for pain and HRQL, respectively)., Results: Mean age was 66.5 years; 47% were male. Median NPS score was 2.2 (out of 10) and mean PCS and MCS scores were 38.0 and 50.5, respectively (scores are standardized to a mean of 50 representing average HRQL). Younger age, living with others, and arthritis were associated with pain. Poorer PCS was associated with being female, venous/mixed ulcer etiology, larger ulcers, longer ulcer duration, cardiovascular disease, arthritis and higher pain intensity. Poorer MCS was associated with younger age, longer ulcer duration, comorbidity and higher pain intensity., Conclusion: Research is needed to test strategies to reduce pain and possibly improve HRQL in high risk groups.