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Dr. John A. Davidson, St. Luke's Hospital

Venous leg ulcers more common in women but often overlooked

Venous leg ulcers affect up to an estimated 600,000 people in the United States every year and account for 80 to 90 percent of all leg ulcers. Venous ulcers develop on the lower leg when the leg veins fail to circulate blood back to the heart normally. Studies have shown that the incidence is higher in women than in men, with some research suggesting it is almost twice as likely in women. The fact that women tend to live longer and also bear children may be the reason for the higher prevalence in women.

Ulcers may or may not be painful. If you have an ulcer, you generally have a swollen leg and may feel burning or itching. You may also have blisters, a rash, redness, brown discoloration or dry, scaly skin with irregular borders. Additional symptoms include leg aching, heaviness, throbbing and cramping. These symptoms usually increase when sitting or standing for long periods of time and decrease with leg elevation.

Despite the prevalence of venous ulcers, treatment is often neglected or is not aggressive enough. People often have a two- to three-year history of ulcers and consider them non-healing or slowly-healing wounds. Risk factors associated with venous ulcers include age, family history, a sedentary lifestyle, obesity, a high salt diet, congestive heart failure, chronic kidney disease and the presence of varicose veins. A duplex Doppler ultrasound may also be used to measure blood flow, vein size and valve function in the leg.

Current conservative treatment of venous ulcers involves local wound care, elevation, salt restriction, long-term compression therapy, walking and treatment of the underlying diseases. Chronic compression therapy is the foundation of treatment because it reduces pressure in the veins, improves the function of the valves and accelerates healing. Surgical treatment options may be considered for larger ulcers or for ulcers that do not respond to conservative measures.

Dr. John A. Davidson practices at St. Luke's Wound Care Center and Hyperbaric Medicine. Call 314-205-6818 or visit his Physician Referral page.

This article was published in the St. Louis Post-Dispatch on January 27, 2011.