Traditional medicine

Stages and types of pathology. Coding of trophic skin ulcers in ICD L93 Lupus erythematosus

The disease is listed in the International Classification of Diseases, 10th revision ICD-10. Due to the large number of etiological factors that can lead to the development of a necrotic process, according to the ICD, the code for a trophic ulcer may be in different categories.

All variants of the ICD 10 code indicating a trophic ulcer on the leg

In the international classification, trophic ulcers of the lower extremities are classified as diseases of the skin and subcutaneous tissue. In this category, trophic ulcers belong to other diseases, i.e. not included in the rest of the classification. The subclass has nineteen sections listing various nutritional and skin pigmentation disorders that are not included in the classification in other subclasses.

The section that includes trophic ulcers is L98, diseases not included in other sections.

Subdivision - L98.4, chronic skin ulcer, not classified elsewhere. But this is a classification of an ulcer if its cause is not established.

Trophic ulcer with varicose veins has a completely different classification. Varicose veins belong to the class of diseases of the circulatory system, a subclass of diseases of the veins and lymphatic vessels.

For varicose veins of the lower extremities, a separate section I83 is allocated, which includes four different variants of the course of the disease, including I83.0 – varicose veins complicated by an ulcer, and I83.2 – varicose veins complicated by an ulcer and inflammation. Varicose veins with only inflammation, but without ulcers, are designated as I83.1, and uncomplicated varicose veins are designated I83.3.

Stages of development

Appearance
Cleansing
Granulation
Scarring

Initial stage The appearance of “lacquered” skin is characteristic. Redness and swelling appears. Liquid seeps through the “varnished” skin. Over time, the dead skin forms whitish spots, under which a scab forms. The first stage can last for several weeks.

At the second stage development of the ulcer has a bloody or mucopurulent discharge. If it has an unpleasant, pungent odor, this indicates the presence of an infection. During the cleansing stage, skin itching appears. As a rule, the second stage lasts about 1-1.5 months.

Healing process trophic wound depends on the quality of treatment. If you follow all the doctor’s recommendations, nutrition and tissue restoration in the area of the ulcer are enhanced. Otherwise, a relapse occurs. Repeated trophic wounds are less susceptible to treatment. At the third stage, the wound surface begins to decrease.

Features of treatment

Trophic ulcers of the lower extremities are treated depending on the type of ulceration and the cause that provoked them. Treatment is prescribed based on histological, bacteriological and cytological examination. Trophic ulcer of the leg can be treated in two ways:

Medication.
Surgical.

Trophic ulcers occupy first place in prevalence along with purulent infections. This disease is long-lasting and painful. Trophic ulcers can form on any part of the skin, but most often they form on the legs - from the foot to the knee. What do you need to know about this pathology and how to treat it?

Causes of the disease

Trophic ulcers are assigned ICD 10 code 183. These are inflammatory wounds that do not heal for a long time. As a rule, they are a consequence of certain pathologies. Trophic ulcers in medicine are not considered an independent disease. The causes of the disease are divided into two groups. The first group includes external irritants: frostbite, burns, radiation exposure, exposure to chemicals, bedsores.

Trophic ulcers of the lower extremities can create quite a lot of troubles not only physically, but also psychologically

The second group includes diseases such as:

diabetes mellitus;
tuberculosis;
AIDS;
syphilis;
disruption of lymph flow;
impaired metabolism;
spinal cord and brain injuries;
autoimmune diseases.

All causative factors have a common feature, namely, an insufficient supply of oxygen and nutrients. Trophic ulcers code 183 according to ICD 10 can be caused by a combination of several causes from both groups. In 70% of cases, the disease is caused by pathologies associated with impaired venous blood flow. One of these pathologies is varicose veins. With varicose veins, venous blood flow is disrupted, which leads to blood stagnation. Venous blood does not contain nutrients, so the skin does not receive substances beneficial to it. In such conditions, it “starves” and gradually breaks down, which leads to the appearance of wounds.

Most often, this pathology develops in the absence of adequate treatment for venous insufficiency and other diseases of the blood vessels.

The second most common cause is venous thrombosis. The lumen of the vessel narrows and because of this the blood stagnates. At the site of thrombus formation, small superficial wounds first appear, which later develop into weeping ulcers.

Stages and types of pathology

ICD 10 trophic ulcers of the leg L97 occur gradually. Insufficient flow of oxygen and nutrients occurs with venous stagnation. Against this background, the tissues begin to become inflamed. First, the inflamed skin becomes thinner and then thickens. Subcutaneous tissue becomes thicker. The skin becomes darker. When tissue trophism is disrupted, the protective properties of the skin are reduced. The result is the appearance of weeping wounds on the lower extremities. Ulcers heal poorly and are prone to relapse.

Doctors classify several degrees of trophic ulcers

Phlebologists distinguish several types of lesions:

venous;
arterial;
diabetic;
neurotrophic;
hypertensive;
pyogenic.

The venous type of ulceration is considered the most common. Often wounds develop on the lower leg. At the initial stage of the disease, heaviness in the legs, swelling, cramps and itching appears. An enlarged vein becomes noticeable on the lower leg. As the disease progresses, the veins merge into spots and acquire a purple tint. The skin becomes dry and smooth. If treatment is not started in a timely manner, the superficial wound deepens and begins to fester. In this case, sepsis may begin.

Arterial ulcerations develop against the background of obliterating atherosclerosis. Hypothermia of the feet or wearing tight shoes can trigger the development of ulcers. Arterial wounds are localized on the foot. This type of defect is round in shape, with ragged and dense edges. Arterial ulcers are painful and cause a lot of inconvenience to a person. Without treatment, ulcerations spread throughout the entire foot.

Diabetic wounds develop in diabetes mellitus. They are very painful. As a rule, they are often susceptible to infections, leading to the development of gangrene or amputation of a limb.

Trophic ulcer: Symptoms, features, causes

The neurotrophic type of ulceration also develops on the feet. They are caused by trauma to the head or spine. These are deep and painful wounds. Hypertensive ulcers form against the background of increased cardiac pressure. This type is characterized by symmetry of the lesion. Wounds develop on both legs at once. With their appearance, a person experiences excruciating pain day and night. Pyogenic ulcers develop against a background of weakened immunity. These are oval and shallow wounds that can be located singly or in groups.

Clinical symptoms

Trophic ulcers of the lower extremities develop in stages, so the signs of pathology can be divided into two main groups:

early (pallor of the skin, itching, burning, cramps and swelling);
late (dermatitis, purulent, mucous discharge, foul odor).

Fourth stage of varicose veins

At the initial stage of development of the disease, the skin becomes thinner. This is due to a deficiency of nutrients and nutrients that are needed for its regeneration. Pallor appears due to insufficient blood volume in the capillaries.

The presence of pathological changes is also indicated by symptoms such as burning and itching. These symptoms cannot be ignored. Without treatment, swelling is added to the symptoms. When blood stagnates, fluid leaves the bloodstream and accumulates in the tissues. Swelling is usually observed in the evening. When there is a lack of oxygen in the tissues and nerve fibers, a person experiences convulsions. They are short-term in nature. Hypoxia also leads to tissue destruction and death. The skin takes on a purple or crimson hue.

As the disease progresses, dermatitis and superficial wounds develop. This is dangerous because pathogens can start a chain of inflammatory processes. Wounds do not heal well. Without treatment, purulent discharge and an unpleasant foul odor appear.

Features of treatment

Trophic ulcers of the lower extremities are treated depending on the type of ulceration and the cause that provoked them. Treatment is prescribed on the basis of histological, bacteriological and cytological examination. Trophic ulcer of the leg can be treated in two ways:

Medication.
Surgical.

Conservative treatment includes taking angiopretectors (acetylsalicylic acid, Heparin), antibiotics (Levomycetin, Fuzidin), as well as medications that stimulate tissue regeneration (Actovegin, Sulfargin). The wound surface is cleaned of pathogenic microorganisms with a solution of potassium permanganate and Chlorhexidine. Alternative medicine is also effective: a decoction of chamomile flowers, celandine, coltsfoot, and string.

Against the background of circulatory disorders, the surface of the lower extremities becomes covered with wounds of a purulent nature. They cause pain, interfere with a full life, and can also lead to death. What reasons provoke the appearance of such a disease? How to properly treat such ulcers?

Types of disease

Trophic ulcers are included in the International Classification of Diseases, 10th revision, code ICD 10. In the corresponding section there is a serial number ICD 10 code L 98.4.2. The disease is a chronic lesion of the skin. Based on the reasons that provoked the formation of purulent wounds, other codes are also identified. If such formations arose as a result of varicose veins, then the ICD 10 code I83.0 is indicated in the classifier. But varicose veins, with ulcers and inflammation, are listed under a different code - I83.2. The following types of ulcers are distinguished:

Venous. Such formations are formed as a result of varicose veins. If treatment is not timely, complications may develop in the form of elephantiasis of the lower leg, sepsis.
Arterial. As a result of obliterating atherosclerosis, purulent formations occur, which are most often diagnosed in older people.
Diabetic. It is the result of a complication of diabetes mellitus.
Neurotrophic. With injuries to the spine and head, craters with pus form on the lateral surface of the heel or sole of the foot. The bottom of the ulcer is bone or tendon.
Hypertensive (Martorella). In people with high blood pressure, papules appear on the surface of the skin, which over time develop into ulcers. This type of disease is characterized by symmetry, so such wounds form on two limbs at the same time.
Infectious (pyogenic). The penetration of infection into the body against the background of reduced immunity can lead to ulcerative formations.

Important! Each type of peptic ulcer disease has its own ICD 10 code.

Reasons

There are many negative factors that can become a trigger for the development of the disease. Trophic ulcers of the lower extremities have a number of causes:

chronic varicose veins;
violations of lymph outflow;
excess weight;
tumors and cysts;
diabetes mellitus;
diseases of the arteries of the legs;
damage to the skin as a result of exposure to chemicals or burns;
failure of the autoimmune system;
problems with the heart, kidneys and liver;
damage to the brain and nerve fibers.

Symptoms

For quality treatment, it is important to diagnose the disease on time. Therefore, you should carefully monitor the condition of your feet. Trophic ulcers of the lower extremities have the following manifestations:

swelling of tissues;
periodic spasms;
pain;
the appearance of a vascular network;
thinning of the skin;
formation of hematomas;
increased skin temperature of the affected area;
pigmentation;
hardening of soft tissues;
the appearance of skin shine and a feeling of tension;
release of lymph to the outside;
detachment of the epidermal layer;
accumulation of pus.

Important! If you regularly experience pain, as well as swelling in the calves and legs, you should be examined by a doctor. This will eliminate the likelihood of complications.

Diagnostics

To make a diagnosis of a purulent disease, you will need to do a number of examinations and tests:

sugar level measurement;
blood and urine tests;
bacteriological and cytological examination;
rheovasography;
Wasserman reaction;
dopplerography;
rheoplethysmography;
phlebography;
infrared thermography.

Treatment

After identifying the causes that led to the ulcer of the foot, leg or calf muscle, a treatment method is selected. Several methods are used to combat the problem: surgical and medicinal. Drug therapy is aimed primarily at cleansing ulcerations of pus and dead tissue particles. For this purpose, antiseptic agents are used, as well as drugs to improve wound scarring and cell regeneration. Medicines are also used to:

normalization of blood circulation and trophism;
reduce the risk of bacterial infection;
relieve pain;
accelerate the healing process of the skin.

The patient is prescribed broad-spectrum antibiotics, anti-inflammatory drugs, and antiallergic drugs. If, after a conservative treatment method, a trophic ulcer of the leg or foot does not stop its development, then the doctor recommends excision of the affected areas of tissue. The following surgical procedures are applicable:

Vacuuming and curettage.
Vac therapy. Low negative pressure is applied to problem areas using polyurethane sponge dressings. Such therapy allows you to create a moist environment in the wound, which leads to improvement.
Virtual amputation. This method is applicable for neurotrophic ulcers. The metatarsophalangeal joint and bone are removed. At the same time, the foot retains its anatomical appearance.
Catheterization. The operation is applicable when the patient is diagnosed with non-healing venous, hypertensive trophic ulcers of the lower extremities.
Sewing a venous-arterial fistula through the skin.

In the case of chronic ulcerative formations, some patients require skin grafting, which consists of grafting a skin flap onto the affected area. Thanks to this operation, a rapid recovery is achieved due to a kind of stimulator of tissue restoration around the wound. To enhance the effectiveness of treatment, the following physiotherapeutic procedures are recommended:

low frequency sound cavitation. Helps enhance the effect of antiseptics and antibiotics on microorganisms inside the wound;
laser therapy. Helps reduce pain and stimulate cell regeneration;
magnetotherapy. Has a vasodilating and anti-edematous effect;
ultraviolet irradiation - to improve local immunity;
balneotherapy.

It is recommended to use compression bandages during treatment and recovery. The limb is wrapped in several layers of elastic bandage, which must be removed every evening and clean ones used in the morning. Thanks to this compression, swelling and the diameter of the veins are reduced, and normal blood circulation and lymphatic drainage are restored.

Varicose veins are a fairly common pathology with many consequences. Varicose disease of the lower extremities ICD 10, in the classification has the code “I 83”. It is a disease that irreversibly affects blood vessels by stretching them and losing their elasticity. Each type of this disorder carries an additional meaning that needs to be known in order to prevent its occurrence.

According to this classification, the disease develops in four stages. Each of the complications has its own classification code and differs in some features. ICD 10 is an international document in which all diseases affecting citizens of the Russian Federation are registered. In addition, the classifier contains statistical data on the percentage of people suffering from the disease, the causes of its occurrence and the degree of damage.

ICD 10, varicose veins of the lower extremities is listed under code 183 and has the following classification:

0 – varicose veins with ulcerative lesions of the extremities;
1 – inflammatory process accompanied by swelling of the veins;
2 – inflammatory process with trophic ulcers;
3 – no complications.

Varicose veins code ICD 10 are irreversible processes that provoke lengthening, stretching, and loss of elasticity of the veins. The veins begin to deform and then the valves collapse.

Reasons for the development of varicose veins

According to statistics, this disease affects women aged 40+ more, but not only adults suffer from it. This predominant age category is explained by the fact that during menopause there are insufficient hormones and an imbalance occurs. This is the cause of this disease. Of all older women, most suffer from varicose veins of one stage or another.

Varicose veins develop by disrupting blood circulation in the extremities. This is due to the deviation of the reverse flow of blood due to damage to the valves and arteries.

In total, there are several factors that are considered fundamental in the formation of pathology. This may be a hereditary, hormonal, or infectious factor. They play the same role for both sexes.

There are a group of the most common reasons that can trigger the onset of the disease:

Wearing uncomfortable clothes and shoes. Wearing synthetic products also plays a role.
Incorrect treatment of diseases.
Poor nutrition.
Alcohol abuse.
Smoking.
Long-term heavy physical loads.
Constant overeating. Due to excessive stress on the intestinal section below, excessive stress may be placed on the veins. Intra-abdominal pressure increases due to excess resistance from the outflow of blood. Subsequently, the load on the legs increases.
Hormonal imbalance.
Changes due to age, causing stretching of the veins and loss of their elasticity.
The presence of congenital pathologies - arteriovenous fistulas.
Surgeries, recent limb injuries.
Use of certain medications.
Having excess weight.

One of the most common causes of the disease is a genetic predisposition. That is, if close relatives had this disease, the probability of the person getting sick is quite high. This can be avoided through preventive measures.

It is not necessarily the tendency to varicose veins that can be transmitted; these may be related diseases, or the anomalies are associated with the mechanism of development of the disease.

Can be genetically transmitted:

disturbances in the structure and functioning of venous valves;
features of the structure and structure of veins;
Collagen and elastin are produced in small quantities. If such a deviation is present, then the vein cannot cope with functional tasks and therefore stretches.

The veins of this risk group can withstand only moderate pressure and loads.

The female sex is more susceptible to the risk of pathology due to frequent hormonal changes. This may particularly be the case during pregnancy, during which CVD often occurs.

Characteristic symptoms of the disease

This disease has a distinctive symptomatic picture. The problem is that pronounced signs appear already in the last stages, which makes treatment difficult.

They are practically no different for both women and men. Therefore, it is worth paying attention to your health if you have even one manifestation that does not go away for a long time.

Symptoms include the appearance of a venous pattern in the extremities and the appearance of a feeling of heaviness and fullness in the legs. In addition, discomfort and pain appear, and cramps in the calf muscles also occur.

Additionally, the patient exhibits the following characteristic symptoms:

Increased fatigue.
Burning and itching in the extremities.
Increased swelling.
The appearance of spider veins, the venous retina is visible.
Deformation of the affected vein.
Bloating, the appearance of lumps and nodes on the veins.
Change in skin color.

If the manifestation is not treated, you may notice the appearance of dermatitis and eczema. Over time, moderate pain turns into severe pain, increasing with exercise. Skin color may turn blue, brown, or red. Subsequently, if treatment is ignored, wounds and ulcers may occur on the affected vein.

If the first symptoms do not go away within a week, you should immediately consult a doctor. Then the treatment will not take much time and effort.

Even if the doctor does not diagnose varicose veins, the cause of such manifestations may be other pathologies that also affect the development of varicose veins.

It can be triggered by:

pathologies of the liver with its increase in size, then the organ is able to put pressure on the vein and overflow it, disrupting blood circulation;
deviations in the functioning of the intestines, in which a violation of its position occurs, then the work of the iliac vein is disrupted, disrupting the functioning of the kidneys and liver;
spasms in the diaphragm of the chest can pinch veins and change blood circulation, this can happen under the influence of psychological stress, muscle imbalance;
pathologies of the gastrointestinal tract with a chronic course;
infectious diseases;
presence of flat feet;
inflammatory diseases in the pelvis;
after any operation.

These diseases significantly increase the risk of developing pathology. This is especially possible during the influence of other risk factors.

In combination with genetic predisposition and lack of movement in life, these chances increase significantly.

Complications arising from varicose veins

In the international classification of diseases, code 183 displays both varicose veins of superficial and deep veins. Superficial veins: small and large saphenous, and deep - tibial, superficial femoral, deep femoral.

Under the influence of the disease, the veins of patients undergo changes in the venous membrane. At first they elongate, then tortuosity. Over time, they atrophy and are destroyed along with the venous valves.

Varicose veins vary according to the international classification:

According to the form of appearance.
Stages of venous insufficiency in chronic form.
Degree of development of complications.

It is also divided according to the form of its occurrence into varicose veins without complications, with changes in blood circulation depending on the location. There are three stages of disease development if chronic venous insufficiency is present. They are divided into: compensatory, decompensatory, subcompensatory.

The compensatory stage is characterized by only some changes in the form of the appearance of a vascular network.

The subcompensatory stage is characterized by deformation of the veins, and increased swelling of the lower leg is also observed. Even a short walk causes discomfort in the legs, a feeling of heaviness and fullness. At night you can experience cramps.

At the decompensatory stage, increased swelling of the legs and feet occurs. greatly expanded, the patient feels pain and itching on the skin. Induration of fiber under the skin is observed. Complications of the disease are associated with the development of thrombophlebitis, thrombosis, bleeding, lymphadenitis, pulmonary embolism, etc.

These pathologies can lead to complex consequences, including death.

Prevention of varicose veins

It is always easier to prevent a disease than to fight it later. Preventive measures for this unpleasant disease will not be difficult for a person.

It should be remembered who needs the prevention of varicose veins in the first place. It is these categories of people who should carefully monitor their health.

It should be carried out for people with a genetic predisposition to the disease. In addition, preventive measures should be carried out by people with typical professions that involve prolonged sitting and standing.

People should also prevent varicose veins:

having excess weight;
wearing uncomfortable shoes and clothes;
female;
old age.

If a person feels tired in his legs, some pharmaceutical products will help him and can eliminate this problem. You should also review your diet so that there are no salty, smoked, or canned foods. You need to adjust your fluid intake. It is necessary to get rid of bad habits, because they provoke the occurrence of damage to blood vessels and the heart.

The International Classification of Diseases has assigned a general code to trophic ulcers (ICD code L98.4.2). However, in accordance with the types of causes and course, the codes for this disease may differ.

Types of trophic ulcers

Phlebologists distinguish the following types of skin pathologies:

The root causes of an ulcer determine its symptoms, course characteristics and therapeutic measures. The international classification of diseases also takes these features into account.

Atherosclerotic

It is a complication of atherosclerosis occurring in a severe, advanced stage. Accompanied by purulent formations localized in the area of the leg and foot. Elderly people in the age category over 65 years are most susceptible to this form of skin pathology.

If there is a predisposition, even minor external factors can provoke the appearance of a trophic type ulcer: wearing uncomfortable shoes, increased physical activity, general hypothermia of the body. (code for atherosclerotic trophic ulcer according to ICD-10 – L98).

Hypertensive

In official medicine it is called Martorell syndrome. An ulcer occurs in patients suffering from hypertension, arterial hypertension, which occurs in the chronic stage. With consistently elevated blood pressure, papules form on the human skin, gradually transforming into painful ulcerative lesions.

A distinctive feature of the disease is symmetry - lesions on both legs appear simultaneously.

Trophic ulcer in diabetes mellitus

Against the background of diabetic pathology, trophic ulcers are a fairly common occurrence. The disease develops as a result of elevated blood sugar levels, disruption of normal trophism, tissue nutrition, and circulatory processes.

This form of the disease is the most dangerous, since in the absence of proper timely treatment of diabetes mellitus, diabetic foot syndrome can cause blood poisoning, gangrene and even amputation of the affected limb.

Venous trophic ulcer

It develops against the background of varicose veins due to disturbances in blood flow, microcirculation and circulation, and venous insufficiency. In the absence of timely measures taken, the disease can lead to the development of sepsis, blood poisoning, and arthrosis of the ankle joint.

Stages of development

A trophic ulcer on the legs develops gradually, going through the following stages:

Appearance - the skin acquires a specific varnish sheen. The affected area turns red and swells. Gradually, white spots form on the skin, under which scabs form. If the pathological process is provoked by infectious factors, symptoms such as fever and general weakness may occur.
Cleansing - at this stage the ulcer itself appears, from which contents of a purulent, bloody, purulent-mucosal nature emerge. The cleansing stage lasts about 1.5 months. The patient suffers from pain and itching.
Granulation - develops against the background of competent therapy, subject to compliance with medical recommendations. This stage is characterized by a decrease in the wound surface.
Scarring is the final healing of a skin lesion, the formation of a scar tissue structure. A long process that can last for several months or more depending on the type, form, and degree of the disease.

Start off treatment Trophic type ulcers are recommended in the initial stages: this increases the chances of achieving positive results and avoids numerous consequences.

Possible complications

In the absence of timely adequate treatment, ulcers in advanced form can cause the development of adverse consequences:

addition of infection;
sepsis, blood poisoning, gangrene;
oncological processes (with prolonged development of non-healing lesions of a purulent nature);
erysipelas;
damage to joints and impairment of their functional mobility;
purulent thrombophlebitis;
amputation of the affected limb.

Doctors emphasize that if trophic type ulcers are not treated, this can lead to the patient’s disability or even death. Timely diagnosis and a set of health measures prescribed by a doctor will allow you to avoid such dangerous consequences.

Treatment regimens

Therapy of trophic ulcerative pathology involves, first of all, identifying its root causes and eliminating the underlying disease. The main method is drug therapy, but an integrated approach is also used:

Internal and oral medications are prescribed for varicose veins, diabetes mellitus, and hypertension. Patients may also be recommended medications for symptomatic therapy with analgesic, antibacterial, and anti-inflammatory effects.
External agents – ointments, gels, solutions. Ulcerative lesions are treated with antiseptics. There is a large list of drugs that have anti-inflammatory, regenerative, and analgesic properties. All medications are prescribed by a doctor depending on the stage and form of the pathological process and general symptoms. The doctor also determines the drug use regimen and the optimal dosage.
Physiotherapy: irradiation, magnetic influence, laser therapy, ultraviolet radiation.

The surgical method involves eliminating the lesion followed by cleansing, and is carried out in the most severe advanced situations, when amputation of a limb may be required.

The optimal scheme of the therapeutic course is prescribed by the attending physician on an individual basis. Folk remedies are used only as an auxiliary element of complex treatment.

Prevention

To prevent the appearance of trophic ulcers, the following recommendations must be followed:

balanced diet;
timely treatment of provoking diseases;
use of venotonic ointments and gels;
cessation of smoking and alcohol abuse.

Trophic ulcers have many varieties and forms, causes of occurrence. However, this pathology progresses quickly and can lead to a number of complications, and therefore requires proper, comprehensive treatment.

Trophic ulcer of the lower extremities - according to ICD-10

A trophic ulcer is a purulent wound. Most often it appears on the lower extremities, namely on the lower leg or foot. This disease progresses rapidly and prevents the patient from leading a full life. Without appropriate treatment, a trophic defect can lead to serious consequences.

Reasons

According to the International Classification of Diseases (ICD 10), trophic ulcers have code L98.4. The development of purulent wounds is associated with disruption of normal blood flow, lack of oxygen and nutrients in the tissues. Trophic ulcers of the lower extremities develop against the background of:

Trophic ulcer is included in the ICD-10 classifier and has code L98.4

lymphatic drainage disorders;
arterial diseases (thrombangitis, Martorell syndrome, macroangiopathy and obliterating atherosclerosis);
injuries;
skin damage.

Trophic wounds, according to ICD 10, can develop against the background of diabetes mellitus or autoimmune diseases. The causative factor may be kidney disease, liver disease, heart disease or excess weight.

Purulent formations can develop for various reasons. They do not act as an independent disease and are always the result of the harmful effects of the external and internal environment. Trophic defects are presented as a special form of soft tissue damage. As a result, wounds heal poorly. A complete diagnosis allows us to identify the root cause of the development of ulcers. Without appropriate examination, therapy does not bring the desired result.

Trophic formations can be hereditary. In this case, the weakness of the connective tissue and the formation of venous valves by it is transmitted from close relatives.

Trophic ulcers are purulent wounds that appear on human skin as a result of a number of reasons.

In medical practice, trophic defects according to ICD 10 have several types:

Untreated varicose veins lead to the development of chronic venous insufficiency. Blood circulation in the lower extremities is impaired. As a result, tissue nutrition deteriorates. The first symptoms of insufficiency are a feeling of heaviness and pain in the legs. Over time, cramps and swelling appear. The skin becomes dark brown in color. Against the background of these changes, weeping wounds form in the lowest parts of the limbs. There is stagnation of blood in the affected area. The tissues do not receive adequate nutrition and accumulate toxic substances. A venous wound is accompanied by skin itching. When injured, the trophic ulcer enlarges and does not heal.

Arterial defects develop as a result of tissue necrosis and disruption of arterial blood flow in the lower extremities. If medical care is not provided to the patient in a timely manner, the affected limb can rarely be saved.

Arterial purulent formations mainly appear on the nail phalanges, foot, heel or toes. Purulent wounds have uneven borders. The bottom of the ulcers is covered with fibrinous plaque.

The problem can occur in any area of the body, but most often affects the feet and legs

The pyogenic type develops as a result of infection. Most often it forms on the lower leg. Purulent defects are caused by hemolytic streptococci, staphylococci or Escherichia coli. Pyogenic ulcers are not deep, with a smooth bottom covered with scab. They never get crusty. Purulent wounds are soft and painful to the touch.

Diabetic type is a complication of type 2 diabetes mellitus. Trophic formations appear in places of strong friction. The feet and ankles are most often affected. The ulcer has purulent discharge. When bacteria or infection are attached, purulent elements may increase in size.

Stages of development

Trophic ulcer of the leg has four stages of development:

It is very important to recognize the disease in time and not to neglect it, but to begin timely treatment

A rapid increase in purulent defect can be caused by a microbial infection. Symptoms include fever, chills and general weakness. When several defects form, the ulcers merge into one large one. Such changes may be accompanied by severe pain and high body temperature.

The last phase can last several months. The healing process is long. Whitish areas of young skin form on the wound surface. The scarring process begins.

The main reason why trophic ulcers form on the body (according to the ICD-10 classification) is a violation of normal blood circulation

Trophic ulcers with ICD 10 code L98.4 progress rapidly, so in order to avoid serious complications it is necessary to begin treatment immediately. Possible complications that can be fatal include sepsis, gangrene or skin cancer.

Therapy

Treatment is prescribed for each patient strictly individually. Before starting treatment, the root cause and type of defect should be identified. For this purpose, doctors conduct bacteriological, histological and cytological examinations. Treatment includes:

drug therapy;
surgical intervention.

At the initial stage of development of a purulent wound, doctors prescribe antibiotics, anti-inflammatory drugs (Diclofenac, Ketoprofen), antiallergic drugs (Suprastin, Tavegil) and antiplatelet agents (Reopoglukin and Pentoxifylline).

Conservative treatment includes cleansing the wound surface of pathogenic bacteria. Purulent formations are washed with a solution of potassium permanganate and chlorhexidine. As an antiseptic at home, you can prepare a decoction of chamomile, string or celandine. After treating the wound, apply a medicinal bandage based on Levomekol or Dioxykol.

Physiotherapy will help enhance the results of local treatment. Ultraviolet irradiation, laser and magnetic therapy are effective. Physiotherapeutic procedures will relieve swelling, dilate blood vessels and stimulate epidermal cells to regenerate.

If drug therapy is ineffective, doctors are forced to resort to radical methods of treatment. In modern medicine, vacuum therapy is performed. The principle of treatment is to use special sponge dressings. Using low pressure, sponge dressings remove purulent exudate from the wound, which leads to a reduction in swelling and restoration of blood microcirculation in the soft tissues. For large areas of damage, skin transplantation is performed from the thighs or buttocks.

Trophic leg ulcers: symptoms, photos of stages

Causes

Venous insufficiency. Thrombosis of the deep veins of the lower extremities and varicose veins can lead to the formation of trophic ulcers on the lower legs.
Arterial insufficiency. Foot ulcers occur due to thromboangiitis and atherosclerosis.
Diabetes mellitus. Pathological processes caused by impaired carbohydrate metabolism lead to diabetic foot syndrome.
Infection of the integumentary tissue with reduced immune defense.
Diseases and injuries of the spine, neurological diseases.

Symptoms

The symptoms of a trophic ulcer appear sequentially:

A feeling of heaviness, increased swelling and night cramps in the extremities, burning, itching and the manifestation of dermatitis or eczema, as well as lymphostasis. The skin in the affected area thickens and pain appears.
The manifestation of a pre-ulcerative condition is atrophy of the epidermis.
Ulcerative damage to the deep layers of tissue with a sharp increase in pain.

Remember that a trophic ulcer is chronic and has the ability to degenerate into a malignant formation!

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Diagnostics

The Center for Modern Surgery offers a full range of diagnostic methods for identifying trophic ulcers, ranging from a clinical minimum of tests to high-precision techniques, such as:

Duplex ultrasound scanning of arteries and veins.
X-ray examination of the affected limb.

Trophic ulcer on the leg, symptoms in the photo

Treatment at the Center for Modern Surgery

The process of treating a disease poses a number of complex tasks for the doctor, requiring an integrated approach, in which it is necessary:

Take measures to eliminate or minimize the manifestation of the disease that led to the formation of the ulcer.
Fight secondary infection.
Treat the trophic ulcer itself.

In the fight against trophic ulcers, our phlebologists use conservative therapy and surgical treatment.

Drawing up a treatment program requires a strictly individual approach to each patient. This is a labor-intensive process that only highly qualified specialists can handle.

Our Center employs professionals who can help people get rid of such a serious illness, as confirmed by hundreds of grateful patients.

Trophic ulcer on the leg

A trophic ulcer on the leg is a defect in the skin and nearby tissues, which is accompanied by inflammation. This deep, wet, purulent wound does not heal for six or more weeks. Trophic ulcers of the lower extremities appear due to impaired blood supply and nutrition of keratinocytes (epidermal cells).

Trophic ulcer according to ICD-10

ICD 10 (International Classification of Diseases, Tenth Revision) was developed by WHO (World Health Organization). Used for coding and decoding medical diagnoses. Trophic ulcer code according to ICD-10 is L98.4.2.

What does a trophic ulcer look like?

deep veins of the lower extremities

A trophic ulcer may look different in a photo. This skin defect changes appearance depending on the duration of the pathological process. First, swelling appears on the leg. Then - bluish spots, which over time transform into several small ulcers.

If the process is started, they will merge together and one large skin ulcer will appear. The wound often emits an unpleasant odor.

A trophic ulcer on the leg festeres and bleeds (see photo).

Symptoms

Early signs of pathology development include:

swelling of the legs (especially after drinking a large amount of liquid, waking up, or sitting in one place for a long time);
heaviness in the legs (first in the evenings, due to physical exertion, then in the mornings);
painful cramps concentrated in the calf muscle (mainly at night);
skin itching;
local increase in temperature (at the site of the ulcer), burning.

As the disease progresses, the following symptoms are observed:

thin winding veins visible through the skin;
shine, bluish pigmentation of the skin;
thickening of the skin;
pain in the affected area;
droplets on the surface of the skin (due to impaired lymphatic drainage).

Stages of trophic ulcer

There are four stages of pathology development:

Stage of appearance and progression. The skin turns red, shines, swells, oozes drops of lymph, then turns white. White spots indicate tissue necrosis. Then a scab forms on the skin and increases in size. A burgundy, weeping trophic ulcer (or several) appears. The duration of the initial stage is from 3-4 hours to several weeks. The occurrence of an ulcer is usually accompanied by weakness, elevated body temperature, chills, severe pain, fever, and loss of coordination.
Purification stage. The formed ulcer acquires round edges, bleeds, festers, and emits an unpleasant odor.
Scarring stage. Pink spots appear on the surface of the ulcer, which over time transform into young skin. The area of the wound decreases and scars appear on its surface. If treated incorrectly, the process may return to the initial stage.
Stage of granulation and epithelialization. It takes several months. As a result, complete healing of trophic ulcers occurs.

A trophic ulcer on the hand has the same stages of development.

Trophic ulcer on the leg photo

Painting the wound

Trophic ulcers of the lower extremities in the photo may have different colors. Coloring tells about the nature of the trophic ulcer and determines treatment tactics:

A dark red wound indicates infection;
Pink color indicates that trophic ulcers on the legs are healing.
A yellow, gray or black trophic ulcer indicates the chronic nature of the pathology.

Types of trophic ulcers

The most common trophic ulcers are:

Atherosclerotic ulcers

The pathology develops mainly in older people: against the background of obliterating atherosclerosis, due to ischemia of the soft tissues of the leg. The arterial trophic ulcer is located on the heel, sole, distal (terminal) phalanx of the big toe, on the foot (from the outside). If you have such wounds, your legs hurt and get cold at night. The skin around the ulcers turns yellow. Pathology occurs as a result

hypothermia of the lower extremities;
foot skin injuries;
wearing tight shoes.

Atherosclerotic trophic ulcers of the feet are small in size, round in shape, compacted, uneven edges, and purulent contents. Their imminent appearance can be predicted by the presence of intermittent claudication in the patient. When the process is neglected, wounds appear on the entire surface of the foot.

Trophic ulcer on the leg with diabetes mellitus

This trophic ulcer is similar to an arterial ulcer in symptoms and appearance, but has two significant differences:

its appearance is not preceded by intermittent claudication;
the wound is deeper and bigger.

Trophic ulcers in diabetes mellitus most often occur on the thumb. Of all trophic ulcers, diabetic ulcers are the most vulnerable to infections, and therefore can lead to the development of gangrene and amputation of the lower limb.

Venous trophic ulcer

Such a trophic ulcer often occurs with varicose veins (symptoms), due to poor circulation in the legs. It is localized on the lower leg, usually on the inner side, below. Sometimes it occurs on the back or outer surface.

Prevention

Trophic ulcers never appear on their own. They are always preceded by other diseases. It is necessary to regularly visit a doctor and monitor the course of existing pathologies, in particular

If you have the above diseases, it is important to follow all doctor’s recommendations.

In addition to this, it is necessary

protect your feet from exposure to low temperatures and sunlight;
Beware of injuries (and if you receive one, contact the clinic immediately).

Ointment for trophic ulcers

There are folk recipes for ointments for healing trophic ulcers. Under no circumstances should they be used! Self-medication can lead to progression of pathology and dangerous complications. You should consult a doctor for qualified medical care. It is not recommended to use ointment for trophic ulcers on the legs on your own. The wound may become clogged, making it impossible to clean. This will lead to erysipelas.

How to smear a trophic ulcer? The wounds are washed with warm water and laundry soap, then an antiseptic for trophic ulcers is used (solution of miramistin, dioxin, chlorhexidine, boric acid).

Tablets for trophic ulcers

Such remedies for trophic ulcers on the legs are also taken only as prescribed by a doctor. Self-administration of painkillers and antibiotics can aggravate the pathology and cause complications. For example, if you take an antibiotic unreasonably for a trophic ulcer, microorganisms that are resistant to its effects may appear in the wound. Also, uncontrolled use of medications can lead to the development of severe allergies.

Treatment

Improper treatment and treatment of a trophic ulcer or lack of therapy leads to complications:

transition of the disease to a chronic form;
spread of purulent-inflammatory processes to muscles and bones;
the occurrence of gangrene;
development of sepsis;
erysipelas;
lymphadenitis;
malignant degeneration.

Trophic ulcer: classification and code according to ICD-10

All variants of the ICD 10 code indicating a trophic ulcer on the leg

E11.5 – for non-insulin-dependent diabetes;

E12.5 – for diabetes with malnutrition;

E13.5 – for other forms;

E14.5 – for unspecified diabetes mellitus.

The section that includes trophic ulcers is L98, diseases not included in other sections.

Subdivision - L98.4, chronic skin ulcer, not classified elsewhere. But this is a classification of an ulcer if its cause is not established.

Stages of development

Appearance
Cleansing
Granulation
Scarring

The initial stage is characterized by the appearance of “varnish” skin. Redness and swelling appears. Liquid seeps through the “varnished” skin. Over time, the dead skin forms whitish spots, under which a scab forms. The first stage can last for several weeks.

At the second stage of development, the ulcer has a bloody or mucopurulent discharge. If it has an unpleasant, pungent odor, this indicates the presence of an infection. During the cleansing stage, skin itching appears. As a rule, the second stage lasts about 1-1.5 months.

The healing process of a trophic wound depends on the quality of treatment. If you follow all the doctor’s recommendations, nutrition and tissue restoration in the area of the ulcer are enhanced. Otherwise, a relapse occurs. Repeated trophic wounds are less susceptible to treatment. At the third stage, the wound surface begins to decrease.

Features of treatment

Causes of the disease

Trophic ulcers of the lower extremities can create quite a lot of troubles not only physically, but also psychologically

The second group includes diseases such as:

diabetes mellitus;
tuberculosis;
AIDS;
syphilis;
disruption of lymph flow;
impaired metabolism;
spinal cord and brain injuries;
autoimmune diseases.

Most often, this pathology develops in the absence of adequate treatment for venous insufficiency and other diseases of the blood vessels.

The second most common cause is venous thrombosis. The lumen of the vessel narrows and because of this the blood stagnates. At the site of thrombus formation, small superficial wounds first appear, which later develop into weeping ulcers.

Stages and types of pathology

Doctors classify several degrees of trophic ulcers

Phlebologists distinguish several types of lesions:

Arterial ulcerations develop against the background of obliterating atherosclerosis. Hypothermia of the feet or wearing tight shoes can trigger the development of ulcers. Arterial wounds are localized on the foot. This type of defect is round in shape, with ragged and dense edges. Arterial ulcers are painful and cause a lot of inconvenience to a person. Without treatment, ulcerations spread throughout the entire foot.

Diabetic wounds develop in diabetes mellitus. They are very painful. As a rule, they are often susceptible to infections, leading to the development of gangrene or amputation of a limb.

Trophic ulcer: Symptoms, features, causes

Clinical symptoms

Trophic ulcers of the lower extremities develop in stages, so the signs of pathology can be divided into two main groups:

early (pallor of the skin, itching, burning, cramps and swelling);
late (dermatitis, purulent, mucous discharge, foul odor).

Fourth stage of varicose veins

As the disease progresses, dermatitis and superficial wounds develop. This is dangerous because pathogens can start a chain of inflammatory processes. Wounds do not heal well. Without treatment, purulent discharge and an unpleasant foul odor appear.

Features of treatment

To speed up the recovery process, drug treatment is carried out in combination with physiotherapy. Ultraviolet irradiation, laser and magnetic therapy have proven themselves to be effective. Physiotherapy relieves swelling, dilates blood vessels and activates cells for regeneration.

In advanced stages, surgical intervention is effective. There are several ways to excise dead tissue and remove inflammation. These methods include vacuum therapy and the catheterization method.

Causes and treatment of trophic ulcers on the leg

A disease such as a trophic ulcer on the leg is observed in more than two million patients worldwide. This disease is characterized by deep damage to skin tissue and is accompanied by an inflammatory process. If treatment is carried out in a timely manner, it is often possible to achieve positive results. Despite all the advances in medicine, treating the disease continues to be a complex process. Even if trophic ulcers of the lower extremities heal, a certain destruction of tissue is observed, and a rather large scar remains at the site of the lesion.

Problems in the treatment of trophic lesions are caused precisely by trophism (lack of cell nutrition). This contributes to a decrease in protective capabilities and some loss of recovery abilities. It is from this concept that the name of the disease comes.

Types of trophic ulcers

Trophic ulcers are also included in the international classification of diseases ICD 10. In the ICD 10 classifier, diseases of this type are classified in the twelfth class. The specialists developing ICD 10 placed trophic ulcers in the interval between L80 and L99. However, in ICD 10 you can find another code corresponding to these lesions. Thus, code I83.0 according to ICD 10 corresponds to an ulcer with varicose veins. The ICD 10 classification of diseases greatly facilitates the work of doctors, because thanks to it it is enough to simply determine the disease code, and, referring to it, prescribe medications and prescribe treatment.

Trophic lesions can be divided into several types, but they all develop as a result of impaired blood supply, lack of nutrition and subsequent tissue death. But the reasons that led to changes in blood supply can be different, which allows us to classify ulcers as follows:

Venous lesions usually affect the legs, with symptoms mainly observed in the lower inner part, the remaining parts being practically unaffected. The reasons for the development are deterioration of blood flow, in some cases a complication of varicose veins. The following symptoms usually appear before ulceration occurs.

There is a feeling of heaviness in the calf, swelling is possible.
Night cramps appear.
Itching of the skin is observed, and a network of thickened veins may appear on the calf.
The veins begin to merge, which subsequently looks like a purple spot, which gradually begins to cover a large area. A color change occurs and the spot may turn purple.
As the pathology develops, the skin thickens and becomes smoother and shinier.

The initial stage of the disease ends with the appearance of white clamps, which look like paraffin flakes. If treatment is not started after these symptoms are identified, skin changes will gradually begin to appear in small ulcers that begin to progress over time. Tissue damage will gradually affect the skin, muscle, tendon and periosteum. The ulcer will begin to ooze pus with an unpleasant odor.

If you treat a venous trophic ulcer late or incorrectly, there is a danger of developing more severe diseases, which may result in irreversible damage. In some cases, tissue damage leads to the development of sepsis and death of the patient.

Arterial and diabetic ulcers

Such a violation of the tissues of the lower leg, like an arterial trophic ulcer, is observed with progressive ischemia, the causes of which lie in obliterating atherosclerosis that affects the main arteries. The most common cause of this type of trophism is hypothermia of the legs and skin damage. These ulcers are usually located on the soles or outside of the feet. They are small, semicircular dimples filled with pus, while their edges are compacted, and changes are visible on the surrounding skin: it becomes pale yellow in color.

In most cases, symptoms of atherosclerotic tissue damage are observed in older people. The appearance of such lesions is preceded by a slight intermittent claudication, rapid onset of fatigue and a feeling of coldness in the legs. If you do not treat the disease already at this stage, then you will not have to wait long for the appearance of ulcers, as well as their growth over the entire foot.

Diabetic ulcers are a consequence of diabetes mellitus, which can lead to the development of many complications. The formation of such an ulcer begins with a decrease in the sensitivity of the tissues of the legs, which occurs as a result of the death of some of the nerve endings. After a short period of time, night pain appears.

The symptoms are very similar to arterial lesions. The only difference is the absence of intermittent claudication. Such ulcers appear mainly on the toes, but the rest of the foot can also be affected. Unlike an arterial ulcer in these trophic lesions, tissue damage penetrates more deeply, and the wound is larger.

The main danger of diabetic ulcers is that their consequence, naturally, if left untreated, quite often is the development of gangrene, leading to the need for amputation.

Neurotrophic and pyogenic ulcers

The causes that result in the occurrence of neurotrophic ulcers on the legs are injuries to the spine and head. These wounds mainly affect the surface of the heels, their lateral surfaces or the sole. Pathologies look like deep craters, sometimes reaching the bone. The external dimensions of such ulcers are quite insignificant, the skin damage may be quite small. There is always an accumulation of pus in the wounds, which emits an unpleasant odor. Damage to tissue in the area of the ulcer leads to a decrease or even loss of sensitivity. Treatment should begin as soon as possible after diagnosis.

Hypertensive ulcers are relatively uncommon. Their formation is provoked by constant increased pressure, causing hyalinosis and spasm of the vascular walls. Initially, a red papule appears, with slight pain. The progression of the disease causes skin disorders and ulcerations. Typically, hypertensive ulcers appear symmetrically, almost simultaneously on both legs. The lesions that appear develop extremely slowly, resulting in severe and constant pain. These trophic disorders have a high risk of bacterial infection.

Prevalence of different types of ulcers among the population

Pyogenic ulcers are formed due to decreased immunity, which is caused by various purulent formations. Most often, tissue damage occurs due to insufficient compliance with hygiene requirements, so people of low social culture are mainly affected. Usually the wounds are shallow and are located both in groups and individually.

Hypertensive trophic lesions are more often diagnosed in women after the age of forty.

Treatment of leg lesions

Treatment of trophic lesions of the legs is carried out strictly individually. Each patient must be treated differently, depending on the cause of the ulcer. Therefore, it is extremely important to make a correct diagnosis before starting treatment. Although the disease code according to ICD 10 may be almost the same, there can be quite a few reasons that provoke the development of ulcers. For accurate diagnosis, doctors resort to various types of studies (cytology, histology, bacteriology, etc.). In addition, instrumental diagnostics are often used.

Doctors begin to treat trophic ulcers only after making an accurate diagnosis. These ulcers can be treated with medication or surgery. Treatment also includes local treatment, which cleanses the ulcer of pus, removes necrotic tissue, antiseptic treatment and the application of ointments for better scarring. In this case, occasionally, after local treatment, bleeding may occur, which is stopped by standard procedures. Treatment with surgical methods involves excision of necrotic tissue and excision of the source of inflammation. It can be treated surgically using a variety of methods, but minor bleeding occurs in almost all cases.

Some forms of trophic ulcers of mild and moderate degrees of development can be treated exclusively with drugs. If trophism is treated with medications, then the process must be divided into several stages, which will be directly determined by the stage of the disease.

Symptoms and treatment of trophic ulcers of the lower extremities, ICD code 10

A disease such as trophic ulcer (ICD 10 code L98.4.2) is a defect of the mucous membrane and skin, which is characterized by a chronic course, accompanied by spontaneous remissions and relapses. Among the many diseases of a purulent-necrotic nature, trophic ulcers occupy a special position, since they occur most often and are extremely difficult to treat.

Etiology and pathogenesis of the disease

The main reason for the development of trophic defects is circulatory disorders, as a result of which tissues cease to receive the necessary amount of oxygen and nutrients. There is a fairly complete classification of such ulcers depending on the etiology of tissue damage. Thus, there are many reasons for the appearance of trophic ulcers:

A combination of unfavorable factors can contribute to the appearance of purulent defects, and it is important to determine the root cause, since only in this case can full-fledged therapy be prescribed. It should be noted that trophic defects are a special form of soft tissue damage, in which the resulting wounds do not heal for a long time. This condition is not an independent disease and always develops against the background of other negative factors of the external and internal environment.

Pathological manifestations

Considering that trophic ulcers are, as a rule, the most severe complication of primary diseases, it is very important for patients to promptly recognize the formation of such a skin defect. The main symptoms of the formation of such a pathology include:

spasms and swelling of tissues;
pain;
chills;
vascular network;
thinning of the skin;
age spots;
hematomas;
hypersensitivity;
hardening of soft tissues;
characteristic shine;
inflammation of the subcutaneous tissue;
increase in local temperature;
the appearance of lymph droplets;
detachment of the epidermal layer;
purulent discharge.

After therapy and healing of the wound, there is a risk of reappearance of the skin defect. At the site of such damage, a fairly thin layer of skin is formed, and there is almost no fat layer underneath. Depending on the severity of the course, even with proper therapy, symptoms of muscle atrophy may be observed, which predisposes to the appearance of a new focus for the development of a skin defect.

Diagnostics and treatment measures

Treatment of trophic ulcers is primarily aimed at treating the underlying disease. Complex therapy involves the use of drugs for both internal use and local treatment of the wound surface. Among other things, medications may be prescribed for:

improving blood circulation;
normalization of trophism;
reducing the risk of bacterial infection of the wound surface;
increasing the regeneration rate;
relief of pain syndrome.

To restore tissue and reduce the risk of re-formation of a trophic ulcer, a number of physiotherapeutic procedures are required.

After tissue regeneration, it is very important for a person to follow the rules of hygiene and follow the doctor’s recommendations in order to prevent a relapse.

Other diseases of the skin and subcutaneous tissue (L80-L99)

Excluded:

birthmark NOS (Q82.5)
nevus - see alphabetical index
Peutz-Jigers syndrome (Touraine) (Q85.8)

Black papular dermatosis

Confluent and reticulate papillomatosis

Wedge-shaped callus (clavus)

Keratosis pilaris due to vitamin A deficiency (E50.8+)

Xeroderma due to vitamin A deficiency (E50.8+)

Excludes: dermatitis gangrenous (L08.0)

Ulcer caused by plaster cast

Note. For multiple locations with different stages, only one code is assigned indicating the highest stage.

Excludes: decubital (trophic) cervical ulcer (N86)

If it is necessary to identify the drug that caused the lesion, use an additional external cause code (class XX).

Excluded:

creeping angioma (L81.7)
Henoch-Schönlein purpura (D69.0)
hypersensitivity angiitis (M31.0)
panniculitis:
- NOS (M79.3)
- lupus (L93.2)
- neck and back (M54.0)
- recurrent (Weber-Christian) (M35.6)
polyarteritis nodosa (M30.0)
rheumatoid vasculitis (M05.2)
serum sickness (T80.6)
urticaria (L50.-)
Wegener's granulomatosis (M31.3)

Excluded:

decubital [compression-caused] ulcer and bedsore (L89.-)
gangrene (R02)
skin infections (L00-L08)
specific infections classified under A00-B99
varicose ulcer (I83.0, I83.2)

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.