ulcerations

Ulcerations refer to the formation of ulcers, open sores that involve loss of the surface epithelium with tissue necrosis and inflammation. They can occur on skin or mucous membranes and are distinguished from simple erosions by the depth of tissue loss.

Common etiologies include vascular insufficiency (arterial or venous ulcers), pressure ulcers, diabetes-related foot ulcers, infections (bacterial, fungal, viral), inflammatory or autoimmune diseases (ulcerative colitis, Crohn's disease with gut ulcers; aphthous ulcers in the mouth), malignancy or premalignant conditions, trauma, and iatrogenic injury (surgical or medical device).

Ulcer formation results from tissue injury exceeding repair capacity. Ischemia, infection, or immune-mediated damage leads to necrosis, followed by inflammatory cell infiltration and breakdown of extracellular matrix. Healing requires re-epithelialization, granulation tissue formation, and angiogenesis, which may be impaired in chronic ulcers.

Ulcers present as a local breach in the skin or mucosa with surrounding erythema, pain, and possible discharge or bleeding. The cause is often suggested by location and history. Diagnosis may involve physical examination, wound assessment, laboratory tests to identify infection or inflammatory disease, imaging for deeper involvement, and biopsy when malignancy or nonhealing ulcer is suspected.

Treatment targets underlying cause, wound care, infection control, pain relief, and nutritional support. Strategies include pressure offloading for pressure ulcers, revascularization for ischemic ulcers, appropriate antimicrobials if infection is present, and topical or systemic therapies to promote healing. Monitoring for complications and cancer risk is essential in chronic or nonhealing ulcers.

Some ulcers heal completely with treatment and risk-factor modification, while others become chronic or recur. Prevention focuses on managing risk factors, regular wound care, and surveillance for malignant transformation in certain ulcer types.