Venous Ulcers

Venous ulcers are open wounds of the lower leg that develop as a result of advanced chronic venous disease. They are associated with prolonged venous hypertension, which can lead to progressive inflammation, skin and soft-tissue changes, and impaired wound healing.

Venous ulcers most commonly occur in the lower leg and ankle region and may develop after progressive skin changes or in areas where the skin has become fragile or damaged.

Chronic Venous Disease Classification (CEAP)

Chronic venous disease is commonly described using the CEAP clinical classification, which identifies the clinical manifestations and severity of venous disease:

C0 – No visible or palpable signs of venous disease
C1 – Telangiectasias or reticular veins
C2 – Varicose veins
C3 – Edema (leg swelling)
C4a – Pigmentation or venous eczema
C4b – Lipodermatosclerosis or atrophie blanche
C4c – Corona phlebectatica
C5 – Healed venous ulcer
C6 – Active venous ulcer

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

Stasis Dermatitis (CEAP C4a)

Stasis dermatitis is an inflammatory skin condition associated with chronic venous hypertension. It commonly affects the lower legs, particularly around the ankle region.

In earlier stages, it may appear as dry, itchy, irritated, or inflamed skin. With more advanced chronic venous disease, skin changes may include persistent redness or inflammation, scaling, brown discoloration, and increasing skin fragility.

Persistent venous hypertension and inflammation can contribute to progressive skin and soft-tissue damage. As chronic venous disease advances, the skin may become increasingly vulnerable to breakdown and venous ulcer formation.

Venous Ulcers vs. Arterial Ulcers

Correctly identifying the cause of a leg ulcer is important because treatment depends on the underlying circulation and cause of the wound.

Venous leg ulcers are associated with chronic venous hypertension resulting from venous reflux, obstruction, or a combination of both.
Arterial leg ulcers develop when inadequate arterial blood flow reduces the delivery of oxygen and nutrients to the tissues, most commonly in patients with peripheral arterial disease (PAD).
Some patients have both venous and arterial disease, resulting in a mixed arterial-venous ulcer.

Distinguishing between these conditions is particularly important because compression is a central component of venous ulcer treatment, while significant arterial insufficiency may limit the amount or type of compression that can be safely used.

Other Causes of Leg Ulcers

Not all leg ulcers are caused by venous disease. Other causes or contributing conditions may include:

Peripheral arterial disease (PAD)
Combined venous and arterial disease
Diabetes, particularly when associated with peripheral neuropathy or impaired circulation
Pressure injuries in patients with limited mobility
Trauma or skin injury
Infection involving the skin or deeper tissues
Less commonly, inflammatory, autoimmune, or malignant conditions

Some wounds may have more than one contributing cause. Accurate diagnosis and assessment of the underlying circulation are important before a treatment plan is established.

Treatment of Venous Ulcers

Treatment of venous ulcers is often performed on an outpatient basis and focuses on wound care, control of venous hypertension, and evaluation of the underlying venous disease.

Depending on the wound and individual clinical findings, treatment may include:

Appropriate wound cleansing and dressings
Debridement of devitalized tissue when appropriate
Compression therapy to control edema and reduce venous hypertension
Treatment of secondary infection when present
Management of surrounding stasis dermatitis and inflammatory skin changes

Because compression is an important component of venous ulcer care, arterial circulation should be considered before significant compression is applied, particularly when peripheral arterial disease is suspected.

Evaluation of the underlying venous circulation may identify superficial venous reflux, perforating vein incompetence, venous obstruction, or a combination of abnormalities contributing to persistent venous hypertension.

When appropriate, treatment of significant underlying venous reflux may be incorporated into the management plan during the course of ulcer care or after healing, with the goals of supporting healing and reducing the risk of recurrent ulceration.

Venous ulcers can heal with appropriate treatment, but healing time varies depending on ulcer size and duration, severity of venous disease, associated edema and skin changes, arterial circulation, mobility, and other individual health factors.

⚠️ Warning Signs That Require Medical Evaluation

Seek medical evaluation if you notice:

A wound that does not heal or repeatedly reopens
Increasing wound size or depth
Increasing redness, warmth, swelling, or pain around the wound
New or increasing drainage or foul odor
Darkening, hardening, inflammation, or breakdown of the surrounding skin
Fever, chills, or other signs of infection
A new wound or area of skin breakdown on the lower leg or ankle

Changes in a leg ulcer may reflect progression of the wound, infection, changes in circulation, or other complications. Early evaluation helps determine the cause and guide appropriate treatment.

Evaluation for Venous Ulcers and Advanced Venous Disease

For non-healing or recurrent leg wounds, venous ulcers, or advanced skin changes, evaluation can help determine the underlying cause, assess the venous circulation, and guide appropriate management.

📞 Call (847) 518-9999 to schedule an evaluation.

International Vein & Skin Institute
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. Non-healing or worsening wounds require appropriate medical evaluation.

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