Hypertensive ulcers

It usually occurs in patients with blood pressure that is long standing and poorly controlled.
Also associated with Diabetes Mellitus
It affects women more than men.
Commonly occur on the outer aspect of back of the lower leg just above the ankle. Over the Achilles tendon is another site of occurrence.
Ulcers typically occur in the absence of significant arterial or venous disease.

Strong, excruciating pain
On Physical examination – solitary or symmetrical, affecting same site on both lower legs
Red-purple inflamed ulcer edge
Irregular shape
Deep, exposing underlying tendons.
Failure to respond to usual treatments for leg ulcers.
Blood tests show elevated C-reactive protein and white blood cells.

Better control of blood pressure
Surgical debridement of the ulcer together with compression therapy, vacuum assisted closure.
In case of large ulcers – skin grafting.
Pain relief – Paracetamol and Non-steroidal anti-inflammatory drugs or opiates in case of severe pain.
Antibiotics may be required for secondary bacterial infection.

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