Sinusitis

How to treat trophic changes in the skin with varicose veins. Trophic disorders in the body

Patients who develop trophic changes in the skin due to varicose veins in the form of ulcers are at particular risk. The likelihood of developing deep ulcerative lesions and infection is very high, which can lead to a serious general condition. Trophic changes in the skin of the lower extremities can accompany many other diseases, the course of which is out of control.

Causes and clinical picture of trophic disorders

The most common “culprits” of problems with the nutrition of the tissues of the affected area are the following diseases:

varicose veins in the legs;
diabetes mellitus, type 2;
obliterating atherosclerosis;
infectious processes of a chronic nature;
cardiovascular failure with edema.

Predisposing factors of the pathological process can be the following body conditions:

overweight;
late pregnancy and the postpartum period;
traumatic injuries.

The first signs of disruption of soft tissue trophism in the area of the affected area are indicated by a change:

skin color (redness or darkening);
elasticity of the skin (it becomes thinner, shiny, peeling);
itching, burning and pain in the legs;
swelling;
the appearance of bubbles with transparent contents.

If the first symptoms of venous insufficiency or other problems with blood vessels and innervation of the legs were ignored, deep damage to the skin and subcutaneous tissue in the form of ulcers with purulent contents may subsequently occur.

Types of trophic changes in the skin of the legs

The appearance of various types of disturbances in the trophism of the outer integument and underlying tissues requires close attention of specialists and immediate treatment of the underlying disease and its consequences.

Lipodermatosclerosis

Edema of the lower extremities of venous or cardiac origin provokes a change in the permeability of the vascular wall, as a result of which the liquid part of the blood penetrates into the subcutaneous tissue and causes gradual destruction of cellular structures. The skin thickens and becomes painful.

Due to lack of oxygen, adipose tissue cells are replaced by connective tissue, and chronic inflammation develops. The lack of therapeutic measures over time leads to trophic disorders in the form of ulcers.

Hyperpigmentation

Darkening of the skin is one of the initial signs of developing trophic changes in the form of ulcers. Pigment spots appear due to the destruction of blood cells penetrating from the vascular bed into the surrounding tissues. Pigmentation is most often located on the inner surface of the legs.

Microbial eczema

Congestion in the veins creates favorable conditions for the development of an infectious inflammatory process on the skin. Bacterial pathogens (streptococcus, staphylococcus) provoke the development of an allergic skin reaction against the background of weakened immunity.

These phenomena lead to the development of eczematous lesions. The patient is bothered by itching, which intensifies at night and in stressful situations. Due to scratching, the inflammatory process progresses, which manifests itself as a pustular lesion with the formation of an ulcer.

Skin atrophy

In places of increased pigmentation, the cover gradually becomes lighter, which occurs as a result of atrophic processes. A sharp compaction of the skin layers leads to the formation of depressions and irregularities, visually the leg decreases in volume.

The terminal stage of trophic disorders is called white atrophy.

Trophic ulcers

Violation of the integrity of the epithelial layer leads to the formation of a skin defect with the formation of an ulcer. Penetration gradually develops, affecting the deep layers of the skin, as well as subcutaneous fatty tissue and muscles.

Diagnostics

Modern examination methods will help to identify the condition of veins and arteries:

duplex scanning of blood vessels;
ultrasonography;
computed tomography of veins;
X-ray method with the introduction of contrast agents into the vascular bed.

To identify the nature of the infection, it is necessary to do a bacteriological analysis of the purulent contents from the wound surface. The results obtained will allow us to select etiological treatment with local drugs.

A clinical blood test will show the degree of the inflammatory process (the number of leukocytes and ESR), as well as the severity of the allergic reaction to eczema (eosinophil content).

Treatment

Health measures have a pronounced effect with a complex effect directly on the lesion and the entire body. Recovery usually does not occur quickly: it takes a long time for the ulcer to epithelize, so you need to be patient and persistently follow the advice of specialists.

To get rid of skin damage due to venous disease, you will need to reconsider your lifestyle:

tidy up your diet;
adhere to the work and rest schedule;
get rid of bad habits;
use an elastic bandage for problem areas.

Medicines

Drug treatment improves venous circulation and metabolism in soft tissues, affects the causative agents of the infectious process in the areas of ulcer formation.

Systemic action

To normalize venous blood flow and tissue trophism, the following means are needed:

venotonics (Detralex, Phlebodia, Troxevasin, Venoruton);
drugs to improve capillary blood circulation (Pentoxifylline, Nicotinic acid, Capilar, Aescusan);
medications that stimulate trophic processes in affected tissues (Actovegin, Solcoseryl);
broad-spectrum antibiotics (cephalosporins, fluoroquinolones, semisynthetic penicillins);
antihistamines (Fenkarol, Cetrin, Claritin);
antioxidants (Tocopherol acetate, Succinic acid, Mexidol).

The duration of the course is determined by the attending physician.

Treatment periods can be long (for venotonic drugs). Antibiotic therapy is carried out in conjunction with intestinal probiotics and antifungal agents.

For topical use

Ointments and creams applied directly to the lesion have a positive effect when the first signs of the disease appear.

To cleanse the wound surface of necrotic masses, Iruksol ointment is recommended. Chloramphenicol (an antibacterial agent in the drug) suppresses the activity of pathogenic microflora.

Local preparations actively inhibit the activity of microorganisms:

Argosulfan;
Levomekol.

A modern way to fight infection is Branolind tissue wipes, which have an effective disinfectant and anti-inflammatory effect.

To wash the ulcer and free it from necrotic tissue, the following disinfectant solutions are used, which can be used to soak the dressings:

Potassium permanganate;
Hexamidine (3%);
Hydrogen peroxide (3%);
0.25% silver nitrate;
Dioxidine;
Miramistina.

Ointments have wound healing properties:

Actovegin;
Solcoseryl.

In cases where it is urgently necessary to relieve the inflammatory process, corticosteroid-based products are used (Celestoderm, Lorinden A, Sinaflan). These ointments are not recommended for long-term use, as they can cause a decrease in adrenal function.

Surgery

In situations where conservative therapy does not have the expected effect, the issue of surgical treatment of ulcers with trophic disorders is decided.

One of the ways to restore venous circulation is to remove the dilated venous node. An alternative to this effect is sclerosis of the affected vein and laser surgery.

To cope with trophic disorders of the skin and underlying tissues, the necrotic area with the ulcer is excised. This accelerates regeneration processes and stimulates repair.

ethnoscience

Compresses and lotions based on the following medicinal plants can produce a therapeutic effect:

chamomile;
calendula;
St. John's wort;
sage;
oak or white willow bark.

Oil from sea buckthorn and rose hips has a pronounced regenerating effect.

Herbal remedies from the arsenal of alternative medicine should be used with great caution and only after consultation with your doctor.

Forecast and prevention of trophic disorders

The appearance of trophic disorders with ulcers on the skin is a prognostically unfavorable sign, which indicates the ineffectiveness of previous treatment for varicose veins.

Therapy tactics include a complex effect using systemic drugs and local agents. If conservative treatment is ineffective within several months, a decision is made on the need for surgical intervention.

Prevention of trophic ulcers consists of timely treatment of varicose veins and compliance with recommendations for lifestyle correction.

Patients with a tendency to trophic disorders of the skin of the legs should wear clothes made from natural fabrics and regularly carry out hygiene procedures. Women should avoid wearing high-heeled shoes.

Trophic disorders of the lower extremities should be treated intensively and in a timely manner: this will avoid decompensation of the condition and trophic disorders of the skin and subcutaneous tissue with the formation of ulcers.

A trophic ulcer occurs on the skin due to decreased tissue nutrition due to impaired circulation and death of neurons. Deterioration of trophism leads to necrosis and rejection of dead cells at the affected area. Treatment of trophic ulcers on the leg is particularly difficult due to changes in oxidative reactions in the area of inflammation and difficulty in cell regeneration, a decrease in local and general immunity.

In 95% of cases, the process forms on the lower extremities and is characterized by a long progressive course and a tendency to relapse.

In most cases, the appearance of trophic ulcers is caused by complications of primary diseases that cause changes in blood vessels, soft tissues or bones. Due to decreased blood circulation and hypoxia, microcirculation disorders and metabolic disorders (acidosis) occur in this area. The affected area becomes necrotic, easily injured and infected with pathogenic microflora. Common causes leading to trophic changes in the skin include:

Venous diseases. In 70% of cases, varicose veins, thrombophlebitis and postthrombophlebitis syndrome become factors in the formation of non-healing wounds on the extremities.
Obliterating atherosclerosis. When cholesterol plaques are deposited on the inner wall of the arteries of the extremities, a blockage of the vessel occurs.
Diabetes. Endocrine disease causes damage not only to the veins, but also to peripheral nerves, bones and joints.
Hypertonic disease. A persistent increase in pressure leads to vascular ischemia.
Congenital malformations of the vascular system. These may be Parkes-Weber-Rubashov syndrome, hemangiomas.
Injuries. Caused by bandaging, squeezing, bedsores, burns or frostbite, and radiation.
Dermatoses. Eczema and allergic skin lesions of a chronic nature.
Autoimmune pathologies. Lead to disruption of systemic blood flow, for example, to Raynaud's disease.

As a rule, ulcers form in the lower leg area, on the sole, and less often on the toes. A photo of a trophic skin lesion is presented below.

Classification and symptoms of trophic ulcers

Violation of trophism in the limb is accompanied by signs that you should pay attention to and immediately begin treatment to prevent the development of ulcers. As a rule, this is heaviness in the legs, pain or loss of sensitivity, swelling of the calf area. Next comes burning and itching, the skin becomes rough, red, and acquires a purple tint.

Classification of trophic ulcers occurs according to several criteria:

according to the severity of the current;
according to morphological characteristics;
by size;
by origin.

According to etiology, trophic wounds are divided into the following types.

Atherosclerotic ulcers

Damage of atherosclerotic origin is located on the outer part of the foot, big toes, and sole. The defect is a consequence of damage to the arteries by cholesterol plaques during obliterating atherosclerosis, which causes stenosis of the veins in the legs or completely blocks the blood flow. Pathology is caused by hypothermia, constant compression of the feet by tight shoes, and violation of the integrity of the skin. The wound is usually small, round in shape with ragged, dense edges and suppuration in the center. The skin around the ulceration is pale, with a yellowish tint. The condition develops more often in older people; deterioration of trophism is indicated by:

difficulty climbing stairs due to pain;
intermittent claudication syndrome;
coldness of the extremities.

If left untreated, small wounds initially form on the foot, gradually increasing in size.

Venous

This type of lesion is formed due to circulatory disorders due to varicose veins or thrombophlebitis, the location is the inner surface of the lower leg. Reduced blood flow causes a lack of oxygen and nutrients, symptoms develop gradually:

At first, a person is bothered by a feeling of heaviness in the legs and swelling, and cramps appear at night.
Over time, the skin begins to itch and swell, and a red-purple network of veins clearly appears on it.
Gradually, the veins merge into a dark spot, the dermis thickens, becomes unnaturally smooth and shiny.
Light-colored, peeling scabs form.

If treatment is not started, a purulent wound forms that constantly gets wet. First, inflammation engulfs the epithelial layer, the progression of the disease leads to damage to muscle tissue, and subsequently the pathological process affects the Achilles tendon. In the advanced stage, the periosteum is damaged and destroyed.

In the video, home methods for treating trophic ulcers:

Diabetic

High blood sugar affects blood vessels and nerve endings. As a result of malnutrition, deep trophic ulcers form in the tissues, which are very difficult to cure even with medications. Sometimes non-healing wounds occur due to trauma to the corns, and due to the lack of innervation, a person loses sensitivity and does not feel the damage. In diabetes mellitus, the areas of greatest friction are predominantly affected - the phalanges of the toes and feet. Self-medication for diabetic ulceration is unacceptable; delayed help leads to gangrene and amputation.

Neurotrophic

The occurrence of wounds is associated with disruption of nerve conduction after injuries to the spine or brain. Ulcers form on the sole, in the area of greatest pressure - on the heel or near the toes. Their sizes are often small, but the tissues are affected deeply, to the bone. The pus that accumulates inside emits an unpleasant odor. Due to the death of nerve endings, sensitivity in the area of damage is reduced or absent, so patients can walk.

Hypertensive

The defect is rare; it affects older people, often women. The second name for the type of ulcer is Martorell syndrome. The cause is arterial hypertension, when prolonged spasm leads to atrophy of small vessels of the extremities. Initially, bluish or pigmented plaques appear on the outer surface of both legs. Then, suddenly or after a minor injury, crusty ulcers form. The progress of changes in the skin is slow, but the wounds are very painful and often become infected.

Pyogenic

The type of ulcers is called infectious, since they develop when pathogenic microflora is introduced due to scratching and poor hygiene in cases of folliculitis, eczema, pyoderma, and microtrauma. The wound is oval, shallow, with a flat bottom and thick purulent contents. The edges are roll-shaped and soft, bluish-reddish in color, the skin around is inflamed. Patients, as a rule, are representatives of asocial groups.

Possible complications

Trophic ulcers gradually grow, increasing the area and depth of tissue necrosis. Wounds are difficult to treat, and prolonged course and improper care can lead to complications of the disease:

erysipelas;
bleeding;
lymphangitis (inflammation of the lymphatic vessels);
phlegmon;
osteomyelitis;
purulent arthritis;
sepsis (infection in the blood);
gangrene.

The consequence of an ulcer can be amputation of a limb. In some cases, untimely assistance ends in the death of a person.

Diagnostics and therapy

Treatment of trophic ulcers of the leg and foot is prescribed after a comprehensive examination of the patient, during which the type and etiological factor of the lesion are determined. The nervous system is examined to determine the presence of hypertension or diabetes mellitus. Attention is paid to the condition of the vessels, lymph and bones on the affected leg, for this purpose instrumental methods are used:

Doppler sonography shows veins and blood flow;
X-rays reveal the stage of the disease.

Macroscopic examination includes bacteriological and cytological tests.

The choice of treatment tactics in each specific case is influenced by the results of the examination:

localization and depth of skin lesions;
changes in microcirculation in tissues;
presence and type of infection;
type of underlying disease.

Depending on the degree of damage and prognosis, conservative or surgical measures are indicated. In the initial stage, the doctor allows you to supplement traditional methods of therapy with traditional medicine.

Operation

Surgical intervention for a trophic ulcer is carried out to remove the source of inflammation - necrotic tissue and pus - in severe cases it involves amputation of the limb. Radical treatment includes procedures:

Curettage, otherwise the cleansing of the wound cavity from pus and dead tissue, with a special instrument - a curette.
Layer-by-layer excision is used in severe cases with deep wounds. After the intervention, skin plastic surgery is required.
Vacuuming is carried out using a device that sucks out foreign inclusions; at the same time, the inflamed surface is irrigated with an antiseptic solution.
VAC therapy is an effective method that represents a local effect on the area of low pressure damage. Innovative treatment technology reduces the contamination of the wound with bacterial flora, removes its contents, maintains environmental humidity, and increases blood circulation. The procedure stimulates granulation, reduces the size of the damage, reducing the risk of complications.
Catheterization is required during a protracted course of the disease, especially with ulcers of hypertensive and venous origin.
Virtual amputation is a resection of the metatarsophalangeal joint while preserving the anatomical structure of the foot.
Percutaneous suturing of the arteriovenous ostium (fistula) to disconnect the vessels. The operation is often performed for hypertensive ulcers at the edges of the injury.

Laser energy helps fight non-healing ulcers. Low intensity radiation - LILI therapy - has an anti-inflammatory, biostimulating and analgesic effect without side effects under highly sterile conditions. Patient reviews of the laser technique are mostly positive.

Drug course of treatment

Treatment of trophic wounds with medications is used after surgery or as an independent course for mild and moderate stages of the disease. Therapy is carried out in stages, the choice of drugs is determined by the degree of development of the pathological process.

In the treatment of trophic ulcers of the lower extremities with weeping wounds, the following is used:

Antibiotics. Broad-spectrum drugs are suitable.
Non-steroidal anti-inflammatory drugs. Medicines based on diclofenac or ibuprofen: Diclofenac, Voltaren, Ibuklin.
Antiplatelet agents. These include "Reopoliglyukin" or "Pentoxifylline". Medicines are indicated to prevent blood clots and are prescribed intravenously.
To prevent allergies, Suprastin or other antihistamines are needed.

At the local level, healing of the ulcer surface requires measures to remove pus, infection, and dead tissue. Treatment includes:

Cleansing with antiseptic solutions: Chlorhexidine, Furacilin, potassium permanganate.
Application of anti-inflammatory local agents that can fight purulent processes - “Levomekol”, “Streptolaven”.
A special adsorbent coating is applied. During the treatment period, hydrogel dressings with silver are effective: “Koloplast Physiotul-AG”, “Atrauman AG”, etc.

If necessary, a blood purification procedure is performed - hemosorption.

During the cell division and healing phase, scars begin to form. The time has come to use gels, creams or ointments that stimulate tissue regeneration - Solcoseryl or Ebermina. Also at the second stage, the following is used for treatment:

Ointment with silver sulfathiazole - "Sulfargin" - is prescribed due to its antibacterial and wound-healing effects.
“Tocopherol” is recommended for eliminating toxins and restoring cell membranes.
Modern wound dressings: Voskopran, Allevin, Geshispon - provide protection and create a microenvironment that accelerates tissue recovery.

In case of diabetes mellitus, the treatment of trophic ulcers includes a mandatory reduction in glucose levels and the organization of dietary nutrition, otherwise it is impossible to achieve a positive result.

After completing the local course of therapy, patients need to take venotonic drugs, immunomodulators and vitamins for a long time.

Home methods

Folk remedies for the treatment of trophic ulcers of the lower extremities are allowed to be used in the initial stages, but only in combination with medications and on the recommendation of a doctor. The following recipes are used at home:

The wound is treated with an antiseptic solution: a Streptocide tablet is crushed into powder and sprinkled on the painful area.
Three layers of gauze soaked in blue iodine are applied to the ulcer. The top is covered with cotton wool and bandaged. After 12 hours, the bandage is removed and the gauze is changed. The course of treatment lasts until the wound begins to dry out and heal.
Propolis (25 g) is finely crushed, butter (200 g) is melted and the powder is poured into it. The mixture is simmered over low heat for 10 minutes, then filtered into a sterilized glass jar through gauze, and after cooling, stored in the refrigerator. The wound and the area around it are treated with an antiseptic, placing a thick layer of mass on a napkin and pressing it to the wound, covering it with cellophane and bandaging it. The compress is kept for a day, this treatment continues until healing.

Prevention

The occurrence of trophic changes in the skin of the extremities is associated with the underlying disease, so the main preventive measure remains treatment of the primary disease at an early stage. It is important to take good care of the skin of the legs and prevent injury in areas with poor circulation. Patients need to choose comfortable shoes and wear elastic bandages for varicose veins, and perform physical therapy exercises.
A trophic ulcer causes suffering and serious complications. Therapy for injuries takes a long time, often leaving large scars on the skin. Therefore, people at risk need to pay increased attention to their health, eliminate bad habits, and follow all doctor’s recommendations for disease prevention.

A trophic ulcer is a defect in the skin or mucous membrane that occurs as a result of tissue malnutrition.

The appearance of trophic ulcers can be provoked by diabetes mellitus, chronic venous insufficiency, thrombophlebitis, obliterating atherosclerosis of the arteries of the legs, allergic dermatitis, diseases of the lymphatic vessels with impaired lymph circulation, burns of the lower extremities.

Before a peptic ulcer occurs, the patient is concerned about swelling and pain in the affected limb, burning and itching, and heaviness in the legs. The skin at the site of the lesion is tense, shiny, purple or purple in color, painful on palpation. Over time, a round or oblong ulcer forms, which does not heal for a long time and causes enormous suffering.

Trophic ulcers are the most common complication of chronic venous insufficiency (CVI) and occur in 2% of the working population in industrialized countries. In elderly people, the frequency of trophic ulcers reaches 4-5%. It is safe to say that the treatment of trophic ulcers is one of the most important medical and social problems of modern society. Despite the obvious progress in the diagnosis and treatment of diseases of the veins of the lower extremities, the prevalence of trophic ulcers of venous origin remains somewhat constant (1–2% of the adult population), identified as a result of numerous studies over the past 30 years. Decompensated forms of the disease are more often observed in elderly patients, however, the initial manifestations of disorders of the trophism of the skin and subcutaneous tissue appear in most patients at a younger age. Trophic ulcers of the lower extremities pose a real threat to many aspects of the quality of life of patients. They are characterized by a low tendency to heal and a long, relapsing course, leading to persistent disability in patients.

How is a trophic ulcer formed?

When medium and small blood and lymphatic vessels are affected, stagnation of blood or lymph is created in them. The trophism of tissues and their supply of oxygen are disrupted. Decay products begin to destroy nerve fibers, and the joining pathogenic microflora aggravates the process.

In diabetes mellitus, trophic non-healing ulcers often form on the big toe and foot. Due to decreased sensitivity and hyperkeratosis, the patient may not notice the pathological process for a long time.

With thrombophlebitis, ulcers usually form on the lower leg.

The causes of trophic ulcers are disorders of the venous circulation that occur with varicose and postthrombophlebitic diseases. As a result of valvular insufficiency of the subcutaneous, perforating and deep veins, the outflow of blood from the extremities is disrupted, chronic venous hypertension is formed, which subsequently initiates a chain of pathological reactions leading to trophic changes and ulcers.

The formation of a venous trophic ulcer occurs, as a rule, in several stages. Initially, an area of hyperpigmentation forms on the skin of the lower leg, usually in the area of the medial malleolus, the occurrence of which is associated with the deposition of the pigment hemosiderin (a product of hemoglobin degradation) in the dermis. After some time, a compacted area of skin appears in the center of the pigmented area, which takes on a whitish, varnished appearance, reminiscent of paraffin deposits. The so-called “white atrophy” of the skin develops, which can be considered a pre-ulcerative condition.

Subsequently, minimal trauma leads to the appearance of a trophic ulcer, which, with timely treatment, closes quite quickly. Otherwise, the area and depth of the ulcer progressively increase, and a perifocal inflammatory reaction of soft tissues occurs - acute indurative cellulitis. Secondary infection with the development of local and systemic purulent-inflammatory complications is possible.

Stages of varicose veins of the legs leading to trophic ulcers

When an open or closed trophic ulcer occurs, the prognosis is always negative; the situation is aggravated, mainly due to the use of improper treatment.

We have already found out that the main cause of trophic ulcers is varicose veins.

Now let’s briefly look at all the stages of varicose veins, which lead to the formation of open, then open trophic ulcers, and also find out what treatment is most often recommended at each stage of the disease.

First stage: Reticular veins and spider veins on the skin.

This problem most often occurs in women (under the influence of natural estrogens, intradermal veins and capillaries expand), when the reticular veins and capillaries are dilated.

Drug treatment can be very diverse. One of the best treatment options for spider veins is microsclerotherapy, during which microinjections of the drug Fibrovein are made. In parallel, it is necessary to use compression mode for several days.

Second stage: Varicose veins.

Varicose veins are the main symptom of varicose veins. The reason is the low efficiency of the vein valves. In addition to aesthetic discomfort, rapid leg fatigue, discomfort and “heaviness in the legs” are often observed. In Europe, the most effective method (efficacy reaches 100%) is Echosclerotherapy (administration of a sclerotherapy drug under the control of an ultrasonic scanner). One of the modern sclerotherapy drugs is Fibrovein. Other methods of treating this stage of varicose veins also deserve attention: laser, radiofrequency and surgical therapy.

Third stage: Significant swelling of the legs.

At this stage of the disease, in addition to treating varicose veins, treatment is required that is aimed at eliminating swelling of the legs. For treatment, diuretics, compression stockings and pneumomassage can be used.

Fourth stage: Beginning of trophic disturbances.

At this stage of development of varicose veins, metabolic processes sharply deteriorate, as a result, the skin of the lower third of the leg darkens, thickens, inflammation forms and the development of the disease becomes less and less reversible. Treatment is similar to the previous stages.

Fifth stage: Open or healed trophic ulcer.

A dangerous stage of the disease that requires special attention and treatment. At this stage there is a very high risk of re-opening of the ulcer or the initial opening of a trophic ulcer.

Sixth stage: Open trophic ulcer.

The most dangerous stage of the disease, requiring immediate and intensive treatment both from the inside and the outside. The use of drugs that improve venous and capillary circulation and eliminate swelling is strongly recommended. In addition to all the previous recommendations, it is required to begin an intensive course of treatment of the open wound and its healing. The most effective drug for the treatment and healing of open trophic ulcers of any complexity is Iruksol. European surgeons primarily prescribe Iruksol for the treatment of trophic and other ulcers, since the use of this drug in the healing of any complex wounds is close to 100%. The use of Iruksol significantly reduces treatment time and does not require special skills and knowledge, except for the doctor’s recommendations.

A survey and examination of the patient will help make an accurate diagnosis and prescribe treatment. General urine and blood tests are required. Discharge from the surface of the ulcer is examined for sensitivity to antibiotics. Ultrasound examination and Dopplerography of the vessels of the legs, angiography are performed.

Use of Iruksol ointment for the treatment of open trophic ulcers

The difference between a trophic ulcer and other types of wounds is that treatment of an open trophic ulcer must begin immediately in order to avoid infection and other more severe complications. Reducing or increasing the duration of treatment for trophic ulcers also depends on the use or non-use of treatment for the causes associated with the formation of trophic lesions and varicose complications in general.

Treatment of trophic ulcers is a complex and long process. The sooner the first trophic changes are noticed, the more successful and faster the treatment will be.

Basic principles of therapy for trophic ulcers:

The use of therapeutic compression hosiery to improve blood and lymph circulation in the affected limb.
Decrease in venous pressure.
Prescription of angioprotectors, antibiotics, antiallergic drugs for oral administration.
Regular toileting of the wound. Local use of anesthetic, antibacterial, wound healing ointments.

The use of Iruksol ointment has a good effect in the treatment of trophic ulcers. It has a comprehensive effect and does not require the use of other local agents. Iruksol ointment cleanses the wound of dead debris, has an antibacterial effect, and accelerates the healing of ulcers. Iruksol is effective for any skin ulceration, regardless of location.

In its combined composition, the ointment contains enzymes that decompose dead tissue, depriving microbes of a nutrient medium, and the antibiotic chloramphenicol has a detrimental effect on pathogenic microflora.

How to properly use Iruksol for the treatment of trophic ulcers

Bandages with Iruksol are applied to the area of the trophic ulcer 2 times a day, although in the first days more frequent changes of bandages are possible. Before applying a bandage, be sure to wash or moisten the surface with saline solution. No other solutions should be used. Zinc paste can be applied to the edges of the wound. The combination of Iruksol with other drugs is contraindicated. Treatment is carried out until the trophic ulcer is completely healed.

The use of Iruksol is contraindicated during pregnancy, lactation, blood diseases and intolerance to chloramphenicol.

In order to prevent the appearance of trophic ulcers, it is important to conduct daily preventive examinations of the extremities, promptly treat any cracks, wounds and abrasions, and also carry out adequate treatment of the underlying disease.

Trophic ulcer of the lower extremities

The term “trophic ulcer” is widely used in medical practice, but is not registered in the International Standard for Classification of Diseases.

Trophic ulcers are non-healing damage to the skin or mucous membranes that arise as a result of diseases that provoke disruption of the local hemodynamics of the circulatory (arterial and venous) and lymphatic systems, including at the microcirculatory level. These changes lead to insufficient tissue nutrition and the development of recurrent ulcers that are difficult to treat.

Their location varies depending on the underlying disease. For example, in case of diabetes mellitus, ulcers form in the area of the feet, in case of chronic venous insufficiency - on the legs.

Types of trophic ulcers and causes of their appearance

Depending on the causes of appearance and the area of damage, ulcers are divided into the following groups:

arterial;
varicose veins (are the most common);
mixed;
diabetic;
postthrombophlebitic;
post-traumatic;
neurotrophic.

The main causes of trophic ulcers are:

stagnation of blood in the veins;
impaired lymphatic drainage;
insufficient nutrition of the tissues of the lower extremities;
fluid retention in the legs.

The last two reasons are a consequence of the first and second. The listed phenomena arise as a result of a number of pathologies and the influence of some other factors. The main ones are:

Varicose veins and thrombophlebitis. These diseases lead to disruption of venous blood circulation, its stagnation, poor nutrition of tissues and, as a consequence, their destruction and the formation of ulcers. In most cases, ulcers of this etiology appear in the lower third of the leg.
Atherosclerosis, in which narrowing of the lumens of blood vessels occurs, as a result of which the tissues do not receive enough essential nutrients and oxygen. This leads to cell necrosis and the development of ulcers. The location of these ulcers is symmetrical: on both sides of the back or front surface of the leg.
Diabetes mellitus leads to inflammation and destruction of the walls of small blood vessels. The result is a disruption of the normal course of metabolic processes with subsequent tissue breakdown. In this case, ulcers form on the feet - mainly on the tips of the toes and the heel.

Other causes of trophic ulcers:

high blood pressure;
thromboangiitis obliterans;
postthrombophlebitic disease;
innervation disorders;
peripheral polyneuropathies of the extremities;
atypical pathologies;
various damage to the skin, peripheral nerves or soft tissues (due to injuries, burns, prolonged irritation, frostbite, wearing tight shoes, etc.

Symptoms of the disease

The symptoms of this disease are quite clear. The first signs are:

significant swelling of the legs;
feeling of heaviness;
burning;
night cramps and spasms (mainly in the calf muscle);
chills;
a network of blood vessels of a bluish tint begins to appear under the skin;
Brown or purple spots subsequently develop: over time, they merge, forming a large area of affected skin with increased pigmentation;
The sensitivity of the skin increases, it acquires a denser consistency and becomes shiny;
as the inflammatory process spreads, it covers the subcutaneous fatty tissue, while the skin loses its elasticity and begins to fold;
there is a local increase in temperature in the affected area;
pain appears in the affected area;
intradermal lymphostasis leads to the release of lymph through the surface of the skin in the form of droplets;
in the central part of the developing ulcer, the epidermis begins to peel off, while the tissues affected by necrosis have the appearance of white streaks of wax - these signs are an indicator of the onset of the pre-ulcerative stage;
when the affected area is traumatized and left untreated, an ulcerative defect develops, which is a focal accumulation of a reddish-cherry-colored substance, covered with a crust (scab) on top;
as the ulcer progresses, the properties of the pathological formation gradually change: fluid with traces of blood, pus, or cloudy effusion with fibrin threads may be released from it;
the accumulation of discharge in neighboring areas also leads to a deterioration in their condition, which provokes the appearance of microbial eczema or erysipelas;
enlarging ulcers merge, the inflammatory process spreads deeper, eventually reaching muscle tissue, tendons, and periosteum.

Diagnosis of trophic ulcers

Since a trophic ulcer is always a consequence of other diseases, the main goal of diagnostic studies is to discover its cause. A thorough examination of the patient is carried out. Particular attention should be paid to the condition of blood and lymphatic vessels, as well as bones.

The venous etiology of the disease is confirmed by the presence of varicose pathology and phlebothrombosis. The likelihood of deep vein thrombosis increases due to certain factors:

long-term use of hormonal drugs;
diseases of the blood system;
catheterization, venous puncture;
chronic pathologies;
prolonged immobility due to injury or illness;
surgical intervention.

Visual diagnosis is based on the characteristic features of a trophic ulcer:

the main place of its localization is the lower leg or foot;
the skin surrounding the lesion is pigmented and significantly thickened;
often the appearance of an ulcer is accompanied by dermatitis or eczema;
palpation reveals the presence of crater-shaped gaps (at these points the altered communicating veins exit through the fascia of the leg);
varicose veins are clearly visible - in most cases they are localized on the back and medial surface of the leg, as well as the back of the thigh.

The following studies are being carried out:

ultrasonic duplex;
X-ray;
rheovasography (diagnosis of blood circulation in the extremities);
study of the general condition of peripheral vessels.

Treatment

Treatment of trophic ulcers is carried out by three main methods:

Local therapy consists of applying bandages with antiseptic, antibacterial and regenerating (restorative) agents to the damaged areas.

Conservative methods are aimed at reducing inflammation and accelerating tissue repair. For this purpose, the following groups of medications are used:

Surgical treatment of trophic ulcers is considered the most effective. The essence of the operation is to remove impassable sections of veins and bypass surgery.

If necessary, dermatoplasty is prescribed, in which the wound defect is covered with the patient's skin or artificial skin. The optimal result can be achieved by combining the surgical method with conservative and local treatment.

Prevention

There are a number of rules that, if followed, will help avoid the formation of a trophic ulcer. They should be observed with particular care in the presence of diseases that create a favorable background for the development of this pathology.

Timely diagnosis and complete (surgical) treatment of varicose veins.
If there are contraindications to surgery for varicose veins, high-quality elastic compression is necessary. Constant wearing of therapeutic knitwear (tights, stockings) or elastic bandages is indicated for any form of postthrombophlebitic pathology.
Proper organization of work.
If you have diseases that contribute to the development of trophic ulcers, you should not engage in heavy static physical work. Prolonged stay in a stationary state (both standing and sitting) contributes to the deterioration of blood circulation and the formation of foci of blood stagnation.
Work in hot shops is also contraindicated.
Proper organization of rest involves raising your legs above the level of your heart.
It is necessary to perform a special set of exercises daily that stimulate the work of the muscular-venous pump of the lower leg. The well-known “scissors” and “bicycle” exercises are great help.
Swimming helps strengthen veins and improve blood circulation.
Since, in the presence of risk factors, any little thing can provoke the development of a trophic ulcer, in case of the slightest injuries or other lesions of the extremities, it is necessary to contact a qualified specialist.

Causes of trophic ulcers - first symptoms, conservative and surgical treatment

Pathological processes that lead to the formation of ulcerative defects have many causes. Doctors who promise a quick cure are more likely to cure the symptom, but do not remove the source of the problem. Trophic ulcers are localized in most diagnostic episodes on the lower extremities (in some cases on the arms) and are skin lesions that do not heal for more than 6 weeks.

What is a trophic ulcer

At its core, it is a trophic ulcerative lesion, which is accompanied by a violation of the upper layer of skin and tissue with damage to the vessels located underneath it (it is not contagious, except for infectious diseases). Such manifestations are often localized on the legs, since they bear the maximum load in everyday life. In addition, ulcers are located on any part of the body where tissue microcirculation is impaired. They look like an ulcerated spot surrounded by skin defects, from which pus, lymph and blood are secreted.

Symptoms

It is difficult to notice the formation of an ulcer, because at the beginning of its development it is no different from a banal bruise. Patients often turn to specialists when a full-fledged surgical intervention is already required to eliminate damaged areas of tissue. If the patient knows that his disease can lead to the formation of such ulcers, then he should carefully monitor the condition of his skin. Signs of ulcerative manifestations and their initial stages of development (using the legs as an example, but all points apply to any part of the body):

Causes

A trophic ulcer is a symptom of a dangerous disease, and not an independent problem. If you treat only a skin problem, then after a while it will appear again (or the treatment will be unsuccessful). When a vascular surgeon makes a diagnosis, he will definitely refer the patient for a full examination to identify the cause of the ulcerative lesion. What can cause trophic ulcers on the legs:

wounds of any type that were not properly treated;
burns;
frostbite;
bedsores;
complication of varicose veins;
chronic vascular diseases;
chemical contact exposure;
radiation or radiation exposure;
constantly wearing inappropriate shoes;
complications of diabetes;
purulent infections
insufficient blood flow in the veins and arteries;
autoimmune diseases;
weakened immunity, including AIDS;
chronic arterial hypertension;
sudden weight gain (occurs in bodybuilders who actively build muscle);
syphilis;
tuberculosis;
brain and spinal cord injuries.

Trophic peptic ulcer disease, depending on the location and cause, can have a different etiology, so accurate diagnosis of the original disease is important. Ulcers begin to form at different levels of tissue, and their types are classified according to the reason for their formation and structure. There are six main types of ulcers:

Arterial (atherosclerotic). They are formed as a result of shear ischemia of the soft tissues of the lower leg (arterial circulation disorder). The initial appearance is provoked by constant or severe one-time hypothermia, uncomfortable shoes, and skin breakdown. Localized in most episodes in the foot area. It looks like small semicircular painful wounds filled with pus, with dense edges and pale yellow skin around. Formed more often in elderly patients with destruction of the arteries of the extremities, formations from the heel to the lower leg increase in diameter and depth.
Venous ulcers on the legs. The initial trigger is a violation of normal venous circulation in the veins, localized within the lower leg. They begin to develop from purple spots. Improper treatment can lead to the growth of the ulcer inward to the Achilles and muscles, and death due to blood poisoning is possible.
Diabetic ulcers. They develop in patients with diabetes if treatment and prevention are not followed; ulcers often form on the lower extremities. Home treatment actually does not produce results; surgery and serious drug therapy are required. Appearance: large diameter sores with deep defects in the tissue, severe bleeding and pus with a strong unpleasant odor (diabetic foot).
Neurotrophic ulcers. Appear after injuries to the head or spine due to disruption of the innervation of the limbs and damage to the nervous structure. Externally they look like small craters that secrete unpleasant-smelling pus. The depth of ulceration can reach tendons and bones.
Hypertensive ulcers (Martorella). The occurrence occurs against the background of malignant arterial hypertension, which leads to the destruction of the walls of small vessels. Outwardly they look like symmetrical small spots of a red-bluish tint with mild pain on palpation. It often develops in women after 40 years of age, the pathology is accompanied by severe pain at any time of the day, and is most prone to bacterial infection.
Pyogenic. Hygienic ulcers that are typical for street dwellers. They appear against the background of furunculosis, purulent eczema when the rules of personal hygiene are ignored. The shape is oval, the depth of ulceration is small.

Complications

Ignoring any disease, regardless of its symptoms, will gradually lead to complications. Trophic ulcers of the lower extremities in this sense are among the most dangerous: purulent processes of small localization are a favorable environment for the development of infections with the gradual destruction of surrounding tissues (a typical example is homeless people with serious pyogenic lesions). What can be the consequences of ignoring trophic ulceration:

eczema of various types around ulcers;
development of fungal diseases;
streptococcal skin lesions;
deformation and destruction of joints, tendons;
vein thrombosis;
cancerous formations in rare cases with total neglect of the problem;
removal of affected muscle tissue;
amputation of totally affected limbs.

Diagnostics

The initial indicators for identifying the presence of such an ulcer are varicose veins and previous phlebothrombosis. Diagnosis occurs after a comprehensive examination of the patient for the presence of diseases that provoke the problem. Primary diagnosis of the disease occurs by palpation of the area of possible localization. If trophic manifestations are suspected (subcutaneous depressions on the legs or calves, hardening of the skin, discoloration), additional ultrasound examination of the leg veins, rheovasography and duplex ultrasound examination are performed.

Treatment of trophic ulcers

How to treat trophic ulcers on the legs if they appear? Long-term therapy for such diseases is a comprehensive approach, which is aimed in parallel at minimizing the impact of the underlying disease and eliminating the non-healing ulcers themselves. Conservative therapy begins with the use of antibiotics to limit the development of purulent lesions and secondary local infections. Separately, drugs are selected to normalize the functioning of blood vessels and the circulatory system, and effectively treat ulcerations.

The ulcers are cleaned using special enzymes. After partial healing and normalization of tissue condition, vessels and veins are surgically restored, and total skin damage is removed. Ulcerated areas should be observed even after the underlying disease has been cured in order to prevent their reappearance due to weakened immunity. There is no strict treatment regimen, because the causes of ulcers and their forms are very different.

Surgery

It is important that primary treatment and surgical intervention are carried out properly, otherwise there is a high probability of secondary progression of trophic tissue damage. The main foci of inflammation, affected areas, and purulent discharge are surgically removed (vascular restoration is a separate category of operations that is performed after the elimination of the ulcerative defect). Treatment of non-healing leg wounds:

vacuum: pumping out pus, reduces swelling, stimulates blood flow and regenerative processes, reduces the risk of relapse, blocks access to bacteria and viruses;
catheterization: used for deep ulcers that are difficult to heal;
suturing venous-arterial fistulas to divide the wound area into smaller wounds for a more targeted effect.

Drug therapy

Invasive therapy is aimed at maintaining immunity, fighting infection and the underlying disease. Treatment of the ulcer itself is often limited to the use of medicinal ointments and creams, which will reduce the bacteriological component and stimulate the tissue to heal. It is impossible to deliver the active substance to the affected area in any other way. Lotions from the compositions are used only after thorough cleaning of the wound.

The ointment is used to stimulate regeneration processes and cleanse the wound. The active ingredients of the ointment normalize blood flow in the vessels, which provokes tissue restoration, even over large areas.

The frequency of use directly depends on the degree of damage to the lesion and the intensity of purulent discharge (on average 2-3 per day).

Solcoseryl actually has no contraindications (except for individual intolerance).

A relatively new drug, the action of which is aimed at restoring the body's immune defense. Stimulates the restoration of blood circulation and stops the appearance of purulent discharge.

You can use the ointment only after consultation with your doctor, because there is a large list of contraindications.

Cannot be used by people with thyroid problems.

Antibacterial action. Relieves pain, burning sensation in the affected area, protects wounds from infections.

The ointment is applied in a thick thick layer to the wound as clean as possible 2-3 times a day to heal the damaged area.

Problems may arise with individual intolerance to sulfathiazole, congenital deficiency of glucose-6-phosphate dehydrogenase. During pregnancy, the ointment can be used if the area of damage does not exceed 20% and the possible benefit outweighs the theoretical risk to the fetus.

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Compression therapy

Fixation with compression bandages is mandatory in the treatment of trophic ulcerative manifestations and varicose veins at all stages of the disease. This effect helps to reduce the diameter of the veins and reduce swelling. Modern technologies suggest using not classic elastic bandages, but specialized compression garments that can be selected according to size and for a specific area of the limb.

Physiotherapeutic procedures

Physiotherapy helps improve microcirculation of the blood vessels of the lower extremities, reduce inflammatory processes in tissues, and promotes healing of ulcers. Such manipulations are permitted if the therapeutic effect does not worsen the condition of the limbs and brings real benefit. Methods differ in the direction of influence:

reduction of inflammation: microwave and UHF therapy;
bactericidal effect: electrophoresis with an antibacterial component (cleanses ulcer localization from necrotic components), aeroionotherapy, darsonvalization (exposure to high-frequency currents);
vasodilating effects: galvanization, infrared irradiation, ultratonotherapy, electrophoresis;
for wound healing, formation of healthy tissues: paraffin therapy, oxygen barotherapy, magnetic therapy;
ozone and air baths.

Traditional methods

It is important to remember that a trophic non-healing defect is not a cold or a callus. A complete cure will occur only after comprehensive treatment of the provoking disease and the ulcer itself. The use of folk remedies must be agreed with the treating specialist in order to avoid worsening the condition or neutralizing the therapeutic effects of traditional therapy. Popular home remedies for treating ulcers:

Burnet tincture. Stimulates the healing of the disease focus and the regeneration of skin areas. The root of the plant must be ground to a powder and pour 100 ml of chilled boiled water. Leave for 10 hours and take 1 tbsp before meals. l. three times a day.
Compress made from birch ash. Pour 100 grams of powder into 1 liter of boiling water, close the container and wrap tightly in a blanket or blanket. After 2 hours, moisten the gauze in the resulting liquid and apply it to the cleaned lesion for 3-4 hours. The procedure should be carried out over 2-3 weeks.
Wraps using golden mustache leaves. Finely chop the leaves and pound in a mortar until the juice appears. Treat the lesion with a sterile solution (hydrogen peroxide or chlorhexidine), place the mixture on the lesion and cover with a sterile bandage (burning may occur in the first minutes). Treat the ulcerated area until complete healing.

Prevention

It is important to remember that ulcerative lesions appear in diseases of the arteries and damage to the venous structure. For varicose veins, when the patient refuses surgical intervention, it is recommended to wear compression garments, which are selected individually. It is strongly recommended for patients to reduce the load on their legs, monitor their weight, if possible, avoid working in hazardous industries (hot workshops), adhere to a strict diet and avoid injury to tissues that are susceptible to ulceration.

Photo of a trophic ulcer on the leg

Video

The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.

An inflammatory skin lesion that does not heal for more than 6 weeks is called a trophic ulcer. Such damage is usually associated with vascular disorders in chronic diseases. It is difficult to treat, often recurs or has a complicated course.

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Types of trophic ulcers

Any trophic ulcer of the lower extremities is a complication of another disease. These skin lesions are accompanied by pain and a long course. They are located mainly on the feet and legs, accompanied by a feeling of heaviness when walking and swelling.

For varicose veins

Atherosclerotic

They develop in place of a large one, leading to destruction of the wall of the arterial vessel. Penetrating ulcers on the wall of the aorta are very dangerous; they become an impetus for internal bleeding.

Neurotrophic

This is the mechanism by which bedsores develop. They are associated with loss of tissue sensitivity and their ability to regenerate as a result of the disappearance of the regulatory function of the corresponding nerves.

The defects penetrate the subcutaneous layer and can extend to the bones. They can occur anywhere on the body, but most often develop on the lower extremities. They are often caused by polyneuropathy in people with diabetes. Loss of skin sensitivity is accompanied by increased pressure on some areas of the foot and damage to the skin there.

Not only sensory, but also motor fibers of the nerves atrophy. Because of this, muscle tone decreases, the arch of the foot loses its shape, which increases pressure on the skin of the sole. Flexion of the foot at the ankle joint is impaired. This puts excess stress on the toes and anterior metatarsals.

Loss of autonomic innervation leads to the cessation of normal functioning of the sweat glands, dryness and increased vulnerability of the skin.

The formation of ulcerative defects is often accompanied by a feeling of burning, numbness or tingling. The usual location is on the ball of the big toe and in the area of the head of the first metatarsal bone. Such a trophic ulcer is surrounded by a dense keratinized edge.

Sometimes it covers the defect so much that a false impression is created that it has healed. When infected, phlegmon, inflammation of the lymphatic vessels, swelling, and purulent discharge with an unpleasant odor often occur.

Hypertensive

This is a rather rare form of trophic ulcer, occurring mainly in women over 40 years of age who suffer. The lesions are symmetrical, develop slowly, are localized on the front of both legs and are characterized by severe pain. Their appearance is associated with the compaction of the walls of blood vessels under the influence of high pressure and constant disruption of tissue nutrition.

Such trophic ulcers easily fester.

Hypertensive leg ulcers

Pyogenic

Pyogenic ulcers are usually small in size. More often they are multiple, located on the entire surface of the lower leg. The skin around the ulcers is red and swollen, and ichor or pus may be released. Such a lesion occurs due to poor personal hygiene and lack of medical care.

Watch the video about trophic ulcers on the legs due to varicose veins and their treatment:

Stages of development

A trophic ulcer has several stages of development:

first, small but painful patches of skin with a bluish tint appear;
then a skin defect occurs, acute inflammation develops with swelling, redness, discharge from the ulcer, and its suppuration;
the healing process gradually begins, proceeding extremely slowly (for a year or more), exacerbations and relapses are possible;
with a favorable outcome, the ulcer is covered with young epithelium, the formation of scars, scars, and depressions at the site of the defect is possible.

Stages of formation of trophic ulcers

Treatment of trophic ulcers of the lower extremities

A set of therapeutic measures is aimed at eliminating or correcting the original disease and preparing the patient for surgery. Surgical treatment is the only way to completely eliminate a trophic ulcer. If surgical intervention is not possible, the efforts of doctors are focused on preventing purulent complications and preventing the growth of the defect.

Drugs

Both general (systemic) medications and local cleansing and wound healing agents are used. In particular, surgeons use:

cleansing the defect using TenderWet dressings, then enhancing tissue growth using the Collost collagen membrane, moisturizing and protecting the wound with Permafoam dressings or Hydrofilm plaster;
sorption of discharge from a trophic ulcer with Sorbalgon and TenderWet plus coatings, and after acute inflammation subsides, use of HedroTac and Hydrotul coatings;
application of Silcofix coating.

Doctors can choose other modern materials for healing trophic ulcers, depending on the hospital’s availability and experience with them.

Systemic drugs are of auxiliary importance in the treatment of trophic ulcers:

medicines based on micronized diosmin (Detralex);
pentoxifylline;
acetylsalicylic acid;
antibiotics.

TenderWet dressing for the treatment of trophic ulcers

Compression bandages

In the treatment of venous ulcers, class 2 - 3 golf socks are important. Such dressings are used over the applied wound covering. They are used only for symptoms.

In general, you need to ensure that the wound dressing is always moist and sterile. This will accelerate the appearance of granulation and the growth of new connective tissue.

How to treat with folk remedies

In the diet, the patient should consume less salt, spices, sauces and sweets.

Surgeons are unanimous in the opinion that self-treatment of trophic ulcers contributes to prolongation of the process and the risk of developing infection. Therefore, folk remedies can only be used as an addition to the main therapy:

pour a tablespoon of celandine leaves with a glass of boiling water, cool, use to wash the ulcer;
Boil one and a half tablespoons of oak bark in a glass of water, leave, and use for rinsing and lotions;
buy aloe, kalanchoe, burdock juice at the pharmacy or prepare it yourself, use it to treat the bottom of the ulcer;
grate raw potatoes, make a compress for 20 minutes;
wash the area of ulcers with laundry soap and make compresses with it.

Preventing leg ulcers

The main means of prevention is timely treatment of diseases that can provoke the appearance of trophic ulcers. After surgery, patients should:

avoid damaging the skin on the operated leg;
refrain from excessive physical activity;
use elastic bandaging or special orthopedic bandages;
eat a lot of fresh vegetables and fruits;
lead a healthy lifestyle, do not smoke;
control blood sugar levels;
undergo training at the Diabetes School and learn all the information about diabetic feet.

Trophic ulcers are associated with impaired arterial or venous blood flow, as well as with impaired nervous regulation of metabolic processes. Such defects occur due to chronic tissue malnutrition, and therefore are resistant to treatment and take a long time to heal. After relieving acute inflammation, the only effective method of getting rid of a trophic ulcer is surgery.

Causes and stages of varicose eczema

Venous eczema occurs more often in older people; there are more women among patients; many, in addition to venous pathology, have concomitant diseases - diabetes, obesity, atherosclerosis.

Factors predisposing to eczema are similar to those for varicose veins - excess weight, prolonged static loads, pregnancy and childbirth, leg injuries, heredity. Chronic infections, decreased immunity, metabolic diseases, and cardiac dysfunction can contribute to skin damage.

The immediate cause of eczematous skin lesions in varicose veins is considered to be a progressive violation of microcirculation, venous insufficiency and stagnation, tissue swelling. If varicose veins are left untreated, the chances of developing eczema increase.

There are several stages of development of venous dermatitis:

At the first stage, initial signs of trophic disorders appear - peeling of the skin, itching, discoloration.
During the second stage, swelling of the soft tissues is noticeable, areas of peeling, erosion, redness, scratching, and blisters appear on the skin.
The third stage is accompanied by peeling of the epidermis in the form of blisters, which open, the wound surface is constantly wet (wetting), and a secondary infection is typical.
At the last stage, the inflammatory process gradually subsides, the wounds become covered with crusts, and scars form.

Manifestations of varicose eczema

Manifestations of varicose dermatitis depend on the stage of the disease, but in many patients it is possible to detect both initial signs and lesions characteristic of later stages of the disease, including scars. The lesion is located on the legs, that is, where varicose veins appear - legs, feet, ankle joints. It is possible to damage one limb or both at once.

The main sign of venous eczema is skin symptoms:

Hyperemia (redness) of an inflammatory nature, the skin is hot to the touch;
Itching, burning, feeling of heat in the affected area;
Swelling of soft tissues;
Vesicles, including those that have opened.

manifestations of varicose eczema

At the first stage, the patient experiences itching, which occurs periodically, in the late afternoon and at night, and is not too intense. The skin becomes red and shiny. Over time, blisters filled with serous contents appear. Soft tissue swelling gradually increases, and pain is possible.

As trophic changes progress, the itching becomes constant and quite painful, scratching appears, and the number of newly formed vesicles increases, which are emptied, giving the skin surface a moist appearance. Such erosions provide a good breeding ground for the proliferation of microorganisms, so secondary infection is a constant component of varicose eczema.

The alternation of periods of exacerbations and temporary improvements leads to further changes in the skin. It becomes dense, acquires a brown or bluish tint, peels off, and areas of scarring alternate with fresh blisters.

The final stage of dermatitis against the background of varicose veins can be not only sclerosis with thickening and thinning of the skin, but also the formation of a trophic ulcer that penetrates deep into the dermis. An infection inevitably develops, which is also facilitated by scratching.

The presence of varicose eczema of the lower extremities changes the gait: the patient begins to limp, trying not to put weight on the affected leg. Dermatitis also affects the general condition of the patient. Considering the chronic inflammatory process, symptoms such as weakness, fever, constant itching disrupt sleep, and the patient becomes restless and irritable are quite likely. Cosmetic defects caused by pathology are also of no small importance, which is why women who are forced to give up skirts and high-heeled shoes are especially worried.

Varicose ulcers characterize an advanced process, when inflammation spreads deep into the underlying tissues, the skin in the ulcer area is necrotic, the wound surface is moist, covered with brown, gray-yellow crusts, and the soft tissues are swollen. At this stage, patients complain of intense itching and pain in the affected limb.

Complications of varicose dermatitis include purulent processes due to the addition of secondary bacterial flora. This phenomenon is very dangerous due to generalization and sepsis, especially in persons with metabolic disorders, diabetes, and severe venous insufficiency.

Treatment of varicose eczema/dermatitis

Varicose eczema requires an integrated approach to treatment - drug therapy, both local and in the form of drugs taken orally, a work and rest schedule, and a balanced diet. In some cases, the question is raised about the need to remove varicose veins surgically. All patients without exception are recommended to wear compression stockings.

Local impact

Local treatment includes various creams, ointments, lotions and baths. It is especially effective in the initial stages of dermatitis. The purpose of local therapy is to moisturize, soften and disinfect the skin. For this purpose, experts advise regularly lubricating the skin of the legs and feet with moisturizing cosmetics and special oils. It is good if the patient gives up regular soap in favor of dermatological gels that more gently cleanse the surface of the skin without drying it out.

Hygiene procedures in conditions of insufficient trophism are very important, so they should not be neglected. You need to cleanse the affected areas of the skin every day, preferably with neutral soap. Wet surfaces are dried using sterile wipes or cotton wool, and the surrounding skin is treated with antiseptic solutions.

If bubbles and moist, eroded areas appear, it is possible to use drying ointments and mash, prepared in a pharmacy according to a dermatologist's prescription. Ointments and creams based on zinc, naphthalan, and silver nitrate can be purchased ready-made; mash will be prepared individually.

Resorcinol, rivanol, silver nitrate solution are used in the form of lotions and are effective due to their antimicrobial, drying and astringent effects. Hormone-based drugs (Lorinden, Sinalar, Advantan) have anti-inflammatory properties and help reduce itching.

In most cases, at stages 1-2 of dermatitis, symptoms decrease with local treatment. To improve trophism and accelerate the healing of erosions and ulcers, drugs that enhance skin regeneration are indicated - solcoseryl, methyluracil.

Drug and surgical treatment

In addition to local therapy, in some cases there is a need for additional treatment with drugs taken orally:

So, if eczema occurs with a microbial infection, you cannot do without antibiotics. For fungal infections, antibiotics are not prescribed; instead, antimycotic agents are used. To relieve itching, antihistamines are used - pipolfen, fenkarol, loratadine. Many patients with severe varicose dermatitis need sedatives - valerian, motherwort, tranquilizers.

Considering that the direct cause of skin lesions is varicose veins and vein pathology, it is advisable to prescribe venotnik and vascular agents (actovegin, pentoxifylline, detralex) internally.

Surgical treatment is indicated for severe forms of dermatitis that are not amenable to conservative therapy. In this case, either the veins are removed during surgery, or minimally invasive and non-surgical techniques are used. Laser treatment and sclerotherapy are very popular.

General tips for treating varicose dermatitis include changing your routine and diet. Patients should avoid standing on their feet for long periods of time, walking long distances (and at the same time physical inactivity); wearing tight shoes and synthetic clothing should be avoided.

To normalize blood flow through the veins, compression hosiery is used - knee socks, stockings, tights, which are selected strictly individually, taking into account the stage of the disease and the parameters of the patient’s legs.

The diet for venous eczema should include foods high in vitamins, especially group B, microelements, and protein. You should limit the consumption of irritating, spicy, spicy foods, alcohol, which provoke an increase in local allergic reaction.

Traditional and alternative therapy also offer a lot of recipes for varicose dermatitis. Among the most popular are baths, lotions with solutions of medicinal plants, and hirudotherapy with leeches.

The use of leeches is due to their ability to thin the blood, thereby improving blood flow in the veins and microcirculation in small skin vessels. The hirudotherapy procedure is unique and not acceptable to every patient, but it is better to carry it out by a specialist with a medical education in a medical institution.

ethnoscience

Folk remedies for varicose eczema are used quite actively, because herbs are available to everyone and can be used at home and independently. Typically, patients prepare decoctions from medicinal plants. Chestnut extract, grape leaves, chamomile and calendula flowers, oak bark, which have antiseptic, wound-healing and anti-inflammatory properties, may be effective.

Healing is helped by the use of various oils - almond, coconut, wheat germ. It is recommended to treat affected areas of the skin with oils after thorough hygiene procedures.

Adherents of traditional medicine can prepare more complex compositions based on medicinal herbs at home. For example, an ointment prepared at home from plants can reduce itching and soften the skin. To obtain it, take a tablespoon of burdock herb, fireweed and chamomile, mix with a spoon of butter and heat in a water bath until a thick substrate is obtained. After the composition has cooled, it is mixed with glycerin and treated the affected skin.

It is easier to treat varicose eczema the sooner you start this process, but prevention of this unpleasant and dangerous complication of venous pathology is no less important. It is important to pay due attention to physical activity - walking, running, swimming, etc. in order to improve the tone of the muscles and veins of the legs. Massage, contrast showers, dousing with cool water are helpful.

When eczema begins, you should not give up movement; on the contrary, it increases microcirculation and accelerates wound healing. It is better to avoid long-term static loads altogether, and if work activity does not allow this, then you should try to minimize the time spent on your feet.

Wearing comfortable shoes, correctly selected in size, and clothing made of natural fabric is a necessity for patients with eczema that has already begun. If with varicose veins ladies are advised to limit wearing high heels, then with dermatitis it is better to completely forget about them, as well as about wardrobe items made of synthetic fabrics.

Varicose dermatitis occurs chronically, for years, leading to irreversible changes in the skin of the legs, therefore, in order not to start the disease and to carry out the most effective treatment in time, you should always consult a specialist. Patients with varicose veins should visit a phlebologist or surgeon at least once a year to monitor the course of the pathology.

The appearance of venous eczema indicates a serious disruption of blood flow in the veins, and the prognosis is not always favorable, because ulcers can form in a matter of months. This form of skin manifestations of varicose veins is the most difficult to treat, but success depends on how quickly the patient gets to the doctor and how carefully he follows his recommendations. Given the effectiveness of some folk recipes, alternative medicine is not able to cure the disease, and self-medication should be completely excluded.

Heavy stress on the legs, which is regular, leads to the problem of varicose veins. Subsequently, if the problem is not treated, trophic ulcers appear on the skin. Such modifications appear as red or even blue spots on the skin and cause pain.

Trophic ulcers can be treated with medication or surgery; if the problem is not very advanced, a person is allowed to use traditional medicine methods. It is possible to be treated for the disease at home, but you must follow all the recommendations of doctors.

The concept of a trophic ulcer

When the circulatory mechanism is disrupted, stagnation processes begin in the veins.

This leads to dilation of blood vessels, varicose veins.

If a person is in no hurry to treat the presented problem, starting it, then trophic ulcers may appear on the skin, and they will not be present on the legs in a single form.

A trophic ulcer is a complication of varicose veins and has pronounced symptoms.

The problem can be described as accurately as possible as follows:

the problem belongs to the category of complications that arise in advanced cases of varicose veins;
trophic ulcer is a problem of severe damage to soft tissues;
pigmentation of the skin in the affected area increases, and dermatitis or eczema additionally occurs;
the skin on the affected area has a matte appearance.

This problem indicates that the blood in the vessels stagnates and the outflow of lymph is disrupted. The problem is accompanied by painful sensations, necrosis of the epidermis is observed, and a dry crust appears on the wound.

Note! If trophic changes in the lower extremities are not treated, then over time the problem can affect the muscles and this will cause incredible pain. In this case, the problem can only be treated surgically.

What types of treatment are commonly used?

Trophic changes in the skin require mandatory treatment. The selection of a method for influencing the problem will depend on the stage of development of the problem in a particular patient. For patients with this disease, the following types of treatment can be used:

Surgical intervention.
Conservative treatment (use of tablets, ointments, injections).
Application of recipes and methods of traditional medicine.
Carrying out physiotherapeutic treatment.

The use of folk remedies should not be done independently.

Before putting any technique into practice, the patient should definitely consult with his or her physician.

Trophic changes in the skin with varicose veins are not only an external problem, but also cause discomfort in terms of sensations.

The larger and deeper the wounds, the more the limbs will hurt; a person will be faced with the concept of severe swelling directly.

Conservative

Conservative or medicinal treatment of trophic ulcers involves the need to drink certain medications and do certain external manipulations using pharmaceutical medications. To perform conservative treatment of trophic skin changes, doctors recommend using the following medications:

antibiotics in the form of creams and ointments externally and tablets internally (do not use iodine and brilliant green);
special pharmaceutical dressings and sponges, bandages;
elastic compression;
non-steroidal anti-inflammatory drugs;
intravenous antiplatelet agents;
antihistamines.

If we talk about the use of specific drugs, then due attention should be given to the drugs Iruksol, Streptolaven, Dioksikol, Levomekol. If elastic bandages are used, they are impregnated with some kind of medicine, applied to the wound and changed as necessary.

It is important! Iodine and brilliant green are also antiseptic substances, but their effect is too harsh and it is because of this that such agents should not be applied to trophic wounds.

Surgical

If you do not pay attention to a trophic ulcer at all, then it becomes a serious problem that will have to be eliminated surgically. Trophic changes in the skin and subcutaneous tissue cause a lot of painful sensations and that is why the problem has to be solved in a hospital setting. The essence of surgical intervention for such a problem consists of the following points:

diseased veins that cause trophic changes are removed;
surgeons are trying to bring the blood flow system of the extremities back to normal;
the problem with impaired lymph outflow is solved.

The operation can be performed under general anesthesia or using epidural anesthesia.

If the second option is used, the person will be conscious, but pain should not be felt.

Folk

Traditional methods are often used to treat trophic ulcers on the skin. There are many remedies that are used to treat this problem, and among them the most popular are:

homemade ointment made from egg whites and natural honey (take one egg white and a tablespoon of honey, mix the ingredients, leave for 3 hours, use as an ointment);
a mixture of egg yolk and iodine (for one yolk you need a jar of iodine);
ointment made from spruce resin, beeswax and lard (take 100 grams of spruce resin, the same amount of wax and lard, boil the ingredients, cool);
potassium permanganate diluted in warm water (you need to take enough potassium permanganate so that when it dissolves, the water has a light pink color).

Most of the products are used to impregnate bandages. Such ointments are applied for at least 6 hours.

Note! Without consulting with your doctor, a person should not use any of the presented traditional medicine methods. If you actively self-medicate, you can make things even worse.

Preventive measures

In order to prevent the appearance of trophic changes in the skin, people need to learn how to carry out competent prevention. The essence of preventive measures will consist of the following points:

do not put too much stress on your legs;
do not wear high heels too often;
if varicose veins occur, immediately engage in competent treatment;
pay close attention to hygiene.

Carrying out prevention will reduce the risk of the problem occurring, but will not be able to get rid of it one hundred percent. There is also such a factor as genetic predisposition to the occurrence of the disease, and it cannot be completely eliminated.

Read about the prevention of varicose veins on the legs at the link.

Conclusion

Treatment of trophic changes in the skin on the lower extremities can be performed in several ways. The treatment method for a particular person should be selected by a doctor. Treatment of this disease will be vigilant and at the same time, attentiveness and also discipline are required from the patient.

Most often, medications are used to perform treatment, but you should not buy them yourself. If this problem occurs, a person should consult a doctor and only together with him select a competent treatment method. Trophic ulcers can become very deep and therefore, the sooner they are treated, the better.

Varicose trophic skin changes: how to treat the disease

What is a trophic ulcer

This term refers to a chronic skin defect, most often in the shin area. Without treatment, ulcers practically do not heal completely and appear again and again; they are caused by varicose veins.

According to many experts, the reason for the appearance of varicose veins in a person was his upright posture, as a result - increased loads on the legs.

And indeed, if you look at any four-legged animal, not one of them will have varicose veins. If the walls of blood vessels are weak initially, the risk of varicose veins only increases.

If the disease is not treated in time, the walls of the blood vessels gradually become thinner, and the elasticity of the skin in the area of the diseased veins decreases.

Tissues cease to receive the required amount of nutrients and oxygen, and the carbon dioxide content, on the contrary, increases. In addition, impaired blood circulation leads to the fact that decay products are not removed from the tissues in a timely manner.

The first sign of trophic changes in the lower extremities is a change in skin color, it becomes darker. In addition, you can notice:

burning and itching;
lymph discharge on the skin;
swelling;
thickening of the skin, the appearance of an unhealthy shine;
dermatitis;
A white spot (dead tissue) appears in the center of the affected area.

Gradually, the ulcer begins to deepen, grow and fester. If there are several trophic formations, they grow together.

Important! Almost all trophic ulcers caused by varicose veins appear in the ankle area.

The development of a trophic ulcer from appearance to healing occurs in four stages:

The appearance and growth of ulcers. In the process, the skin cells around the wound are destroyed.
Purulent discharge.
Scarring. During this period, the body tries to cope with the ulcer on its own.
Restoration of the affected skin area.

The whole process takes on average about 1.5 months. However, the greatest danger of ulcers is in relapses. In advanced cases, tissue damage becomes deeper, reaching the bones.

Some of the most severe consequences of trophic skin lesions are cancer and gangrene, which in the final stages leads to amputation of the limb. Therefore, at the first symptoms, you should consult a doctor and do not try to cope with the disease on your own.

Types of treatment for trophic ulcers with varicose veins

The type of treatment for trophic leg ulcers depends on the stage of the disease and the individual characteristics of the patient. Of all the directions, three of the most famous can be identified:

Conservative treatment.
Surgical intervention.
Ethnoscience.

At the same time, doctors are skeptical about traditional methods of treatment. This is primarily due to the fact that too much time must pass to achieve the effect of the same herbal medicine. Additionally, herbs and poultices will not help cure ulcers in their advanced stages.

Ulcers need to be treated only together with the underlying disease. Since varicose veins are not the only cause of trophic changes in tissues, a complete diagnosis of all body systems will be required.

Conservative treatment

Conservative treatment includes drug therapy, washing of ulcers and their subsequent treatment. To achieve the desired effect, a set of measures is used:

Treatment aimed at improving blood flow and dissolving blood clots.
Cleansing the ulcer from pus.
Wearing therapeutic underwear.
Therapeutic gymnastics and massage.

To treat trophic changes in the skin with varicose veins, regular wound treatment with antiseptic agents is required. This is necessary to prevent suppuration.

In addition to antiseptics, wound healing and anti-inflammatory ointments are used. Also, do not forget about drugs aimed at strengthening veins and small vessels.

Infectious diseases make treatment difficult, so it is important to maintain immunity during this period. To do this, you need to take a complex of vitamin preparations, as well as carefully monitor your health.

Surgery

The most effective method of treating trophic ulcers. It includes any variants of surgical interventions, including plastic surgery with transplantation of healthy skin to the affected area. In addition to transplantation, the affected areas of the veins are removed.

Before any surgery, ozone therapy is first performed to cleanse the ulcer of bacteria. Recovery after skin graft surgery is quick, and the patient feels no pain the very next day.

Extreme measures include amputation of limbs. This can happen if the patient does not follow the doctors’ recommendations after surgery.

If you ignore further therapy using topical medications, the ulcer will return again. If treatment is delayed, the risk of skin cancer only increases.

Traditional methods

Despite the achievements of modern pharmacology, herbal medicine is still popular. Sometimes doctors themselves recommend herbal treatment, but only in combination with the main therapy.

Most often, homemade ointments and compresses, herbal baths are used, and sometimes patients take decoctions or tinctures orally. This treatment is effective only in the initial stages of the disease, here are some simple recipes:

Tar ointment. To prepare this remedy you will need 100 grams of tar (juniper), two raw yolks and a few drops of rose oil. The ingredients are mixed until smooth. The ointment is applied to the affected area for 20 minutes twice a day.
Lungwort. The herb can be used fresh or in decoction. Crushed fresh leaves are applied to the wound as a compress for 30 minutes daily. A decoction of dry lungwort is used to wash trophic ulcers 6 times a day.
Blue clay. The healing properties of clay are well known; dry powder can be purchased at a pharmacy at an affordable price. The clay is diluted according to the instructions on the package and applied to the ulcer for the specified time.
Streptocide ointment. For preparation you will need 1 tablespoon of unrefined vegetable oil, the same amount of fish oil and 25 streptocide tablets. The oil is boiled in a steam bath for 20 minutes, then fish oil is added and wait another 20 minutes. The last thing to add is streptocide powder from crushed tablets; the mixture should be kept on the fire for another half hour. The finished ointment is applied to the affected areas of the skin and bandaged.

Before using ointments and compresses, the skin must first be disinfected. All bandages used must be sterile to avoid introducing infection into the wound.

Important! Most folk recipes contain allergenic components. Before using ointments, you should first test their effect by applying a small amount to the crook of your elbow or wrist. If nothing happens within 24 hours, the product can be used.

Preventive measures

Preventing trophic changes in the skin and subcutaneous tissue due to progressive varicose veins is much easier than treating the consequences. Therefore, it is important to take measures not only against the appearance of ulcers, but also to try to prevent the appearance of varicose veins. What can be done:

Take medications that strengthen the walls of blood vessels and improve blood circulation.
Lead an active lifestyle, play sports, and when working sedentarily, try to find time to warm up.
Avoid drinking alcohol.
Wear comfortable clothes and shoes that do not pinch the blood vessels of the legs.
If you already have varicose veins, you will need to wear compression garments regularly. You can choose stockings or knee socks only after consulting a doctor.
Yoga exercises are useful for improving blood circulation, especially exercises in which the legs are located higher than the level of the body.

And the main thing in preventing the disease is regular visits to a phlebologist for preventive examinations. Then it will be possible to detect the disease in the early stages and quickly treat it without serious consequences and costs.

Conclusion

Complications from trophic ulcers caused by varicose veins are too serious to neglect timely treatment and prevention. An integrated approach to the treatment of ulcers and the underlying disease will quickly restore health to the legs and veins.

One of the most serious consequences of varicose veins is trophic changes in the skin on the legs. Ulcers are difficult to heal, and their treatment takes time; if you miss the moment, there is a high risk of losing your leg. This is why it is so important to treat varicose veins in the early stages, even before the formation of non-healing wounds.