Venous Ulcers

Venous ulcers are open wounds that develop as a result of advanced chronic venous disease. They occur when long-standing venous insufficiency leads to persistently elevated venous pressure, progressive skin damage, and failure of normal wound healing mechanisms.

Chronic Venous Disease Classification (CEAP)

Chronic venous disease progresses in predictable stages and is commonly classified using the CEAP system:

C0 – No visible or palpable signs of venous disease
C1 – Telangiectasias or reticular veins
C2 – Varicose veins or recurrent varicose veins
C3 – Edema (leg swelling)
C4a – Skin pigmentation or venous eczema
C4b – Lipodermatosclerosis or atrophie blanche
C4c – Corona phlebectatica (bluish veins around the ankle area)
C5 – Healed venous ulcer
C6 – Active or recurrent active venous ulcer

An open venous ulcer (CEAP C6) represents the most advanced stage of chronic venous disease.

Stasis Dermatitis (CEAP C4a)

Stasis dermatitis is an inflammatory skin condition that occurs in some patients with chronic venous insufficiency.

In early stages, it often presents as dry, itchy skin or a rash on the lower legs that worsens with scratching. Over time, inflammation may progress to persistent redness, scaling, brown discoloration, thinning of the skin, and increased skin fragility.

If venous hypertension is not addressed, stasis dermatitis may eventually lead to skin breakdown and venous ulcer formation.

Venous Ulcers vs. Arterial Ulcers

Correctly identifying the cause of a leg ulcer is critical, as treatment strategies differ significantly.

Venous leg ulcers result from prolonged venous reflux or obstruction, leading to increased venous pressure and impaired tissue healing.
Arterial leg ulcers are caused by inadequate arterial blood supply, most commonly due to advanced atherosclerosis and peripheral arterial disease (PAD).

Because of these differences, venous ulcers and arterial ulcers require entirely different treatment approaches.

Other Causes of Leg Ulcers

Not all leg ulcers are venous in origin. Other potential causes include:

Combined venous and arterial insufficiency
Long-standing or poorly controlled diabetes mellitus, resulting in impaired microcirculation and/or peripheral neuropathy
Pressure ulcers in bedridden or immobile patients
Severe skin infections that progress to ulceration
Rarely, malignant or metastatic skin lesions

Accurate diagnosis is essential before initiating treatment.

Treatment of Venous Ulcers

Treatment of venous ulcers is typically performed on an outpatient basis and does not usually require hospitalization.

Early treatment may include:

Gentle debridement of devitalized or infected tissue when appropriate
Topical or systemic antibiotics for secondary bacterial infection
Customized wound dressings
Multilayer compression therapy to reduce venous pressure

Once an ulcer has healed or improved, evaluation and management of underlying venous reflux may be considered to help reduce the risk of recurrence.

In contrast, arterial ulcers are often treated in a hospital setting and may require arterial stenting or bypass surgery.

Many venous ulcers respond to appropriate treatment; however, healing time varies depending on ulcer size, duration, disease severity, and individual patient factors.

⚠️ Warning Signs of Ulcer Progression

Seek medical evaluation if you notice any of the following changes in the lower legs:

A wound that does not heal or repeatedly reopens
Increasing pain, swelling, or heaviness in the leg
Redness, warmth, drainage, or foul odor from the wound
Darkening, hardening, or thinning of the surrounding skin
Rapid increase in wound size or depth
Signs of infection such as fever or chills

Early evaluation may help identify underlying causes and reduce the risk of complications.

Evaluation for Advanced Venous Disease

For non-healing wounds or advanced skin changes related to venous disease, an evaluation can help clarify the cause and guide appropriate management.

📞 Call (847) 518-9999 to discuss evaluation options.

International Vein & Skin Institute
Dr. Jozef Tryzno, MD, RVT, DABVLM
Diplomate, American Board of Venous & Lymphatic Medicine
Registered Vascular Technologist

Medical Disclaimer
The information provided on this page is for educational purposes only and is not intended to replace professional medical evaluation, diagnosis, or treatment. Individual medical conditions and treatment recommendations vary. Always consult a qualified healthcare provider regarding your specific medical concerns.

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