Insuficiência venosa

Insuficiência valvular profunda, superficial ou das comunicantes

Aplasia/hipoplasia congénita valvular

Fragilidade das paredes venosas (distúrbios do colagénio)

Anatomose arteriovenosa, angiodisplasia

Compressão/obstrução venosa (tumores, linfadenopatias, trombose veias pélvicas)

Ruptura de varizes, trombofletite ulcerada

Oclusão arterial

Doença arterial periférica (arteriosclerose)

Trombose arterial/tromboembolismo (fibrina, plaquetas)

Embolismo gordo (hipercolesterolémia, hipertrigliceridémia)

Tromboangeíte obliterante (Doença de Buerger)

Anastomose arteriovenosa (congénita/traumática)

Displasia fibromuscular

Traumatismo, ruptura, infecção, procedimentos vasculares (síndrome do dedo azul)

Distúrbios microcirculatórios

Fenómeno de Raynaud, esclerodermia

Hipertensão arterial (úlcera hipertensiva de Martorell)

Aumento da viscosidade sanguínea (aumento do fibrinogénio, paraneoplasia, paraproteinemia)

Reacções transfusionais 

Lesão física ou química

Pressão (decúbito prolongado)

Traumatismo, queimaduras (calor/frio)

Agentes corrosivos (cimento), escleroterapia

Artificial (automutilação/factícia)

Neuropatias

Diabetes mellitus, lepra, neuropatia alcoólica, tabes dorsalis, espinha bífida, paraplegia, esclerose múltipla, poliomielite, siringomielina

Doenças Infecciosas

Bactérias - Erisipela bolhosa, ectima, fasceíte necrótica (Streptococcus haemoliticus), gangrena gasosa (Clostridium), ectima gangrenoso (Pseudomonas), embolismo séptico (Meningococcus e outros), antrax (Bacillus anthracis), lues maligna (sífilis terciária, goma sifilítica – Treponema pallidum), tularemia (Franciscella tularensis), angiomatose bacilar (Bartonella spp) micobacterioses (M. leprae, M. tuberculosis, M. ulcerans)

Fungos - Pé de Madura (micetoma), chromomicose, blastomicose, esporotricose (Sporothrix schenckii), coccidiomicose (Coccidioides immitis), histoplasmose (Histoplasma capsulatum), granuloma tricofitico (Trychophytum spp.)

Vírus – Herpes zoster, herpes simplex, citomegalovirus

Parasitas – Leishmaniose, doença das Chagas (Trypanosoma cruzi)

Vasculites

Pequenos vasos: vasculite leucocitoclásica, poliangeíte microscópica, granulomatose de Wegener, doença de Churg-Strauss, púrpura de Henoch-Schönlein, crioglobulinemia essencial, eritema indurado de Bazin, livedo reticular, síndrome de Sneddon

Médios vasos: poliarterite nodosa, doença de Kawasaki

Doenças hematológicas

Drepanocitose, talassemia, esferocitose hereditária, deficiência de glicose-6-fosfato desidrogenase, trombocitemia essencial, púrpura trombocitopénica trombótica, policitemia vera, disproteinemias monoclonais (mieloma múltiplo, doença de Waldenström), disproteinemias policlonais (criofibrinogenemia, aglutininas frias)

Distúrbios da coagulação

Factor V de Leiden, anticoagulante lúpico, anticardiolipinas (síndrome antifosfolipídico), alterações da fibrinólise, deficiência de factor XIII, de antitrombina III, das proteínas C e S, coagulação intravascular disseminada, púrpura fulminante

Doenças metabólicas

Diabetes mellitus, necrobiose lipoidica, porfiria cutânea tarda, gota, calcifilaxia, calcinose cútis, hiperoxalúria, deficiência de prolidase

Neoplasias

Neoplasias cutâneas primárias (basalioma, carcinoma espinocelular, melanoma)

Doença cutânea metastática (neoplasias viscerais ou hematológicas)

Transformação maligna de úlceras de longa duração (úlcera de Marjolin)

Sarcoma de Kaposi

Úlceras secundárias a fármacos

Injecção intralesional de corticoides, hidroxiureia, varfarina, cumarínicos, heparina, BCG, ergotamina, metotrexato, factor estimulante de colónias de granulócitos

Dermatoses ulcerativas

Pioderma gangrenoso, dermatoses bolhosas (penfigo, penfigóide, epidermólise bolhosa), paniculites, periarterite nodosa, eritema indurado de Bazin, eritema elevatum diutinum, doença de Degos, sarcoidose, doença de Beçhet, lúpus eritematoso sistémico e discóide, dermatite de contacto, esclerodermia, mixedema, eritromelalgia, perniose, hemangioma, artrite reumatóide (síndrome de Felty), síndrome de Klinefelter, liquen plano, necrose pancreática gorda, picadas de insecto, linfedema

Venous insufficiency

Venous valve insufficiency in the deep, superficial or  venae communicantes

Congenital hypoplasia ⁄ aplasia of venous valves

Weakness of the venous wall (collagen disorders)

Arteriovenous anastomosis, angiodysplasia

Compression or obstruction of veins (tumors, lymphadenopathy, pelvic vein thrombosis)

Ruptured varices, ulcerating thrombophlebitis

Arterial occlusion

Peripheral arterial disease (arteriosclerosis)

Arterial thrombosis ⁄thromboembolism

Fat embolism (hypercholesterolaemia, hyperlipidaemia)

Thromboangiitis obliterans (Buerger disease)

Arteriovenous anastomosis (congenital ⁄traumatic)

Fibromuscular dysplasia

Trauma, rupture, infection, vascular procedures (blue toe syndrome)

Microcirculatory disorders

Raynaud phenomenon, scleroderma

Ulcus hypertensivum (Martorell ulcer)

Increased blood viscosity (increased fibrinogen level, paraneoplastic, paraproteinaemia)

Blood transfusion reactions

Physical or chemical injury

Pressure (decubitus)

Trauma, burn wounds (cold/hot)

Corrosive agents (ex. cement), sclerotherapy

Artificial (automutilation/facticial ulcers)

Neuropathic diseases

Diabetes mellitus, leprosy, alcohol neuropathy, tabes dorsalis, spina bifida, paraplegia, multiple sclerosis, poliomyelitis, syringomyelia

Infectious diseases

Bacteria - Erysipelas bullosa, ecthyma, fasciitis necroticans (Streptococcus haemolyticus), gas gangrene (Clostridium),

ecthyma gangrenosum (Pseudomonas), septic embolism (Meningococcus and others), anthrax (Bacillus anthracis),

Diphtheria (Corynebacterium diphteriae), lues maligna (gummata - Treponema pallidum), tularaemia (Franciscella tularensis), Bacillary angiomatosis (Bartonella spp), Mycobacterial infections (M. leprae, M. tuberculosis, M. ulcerans - Buruli ulcus)

Fungus - Madura foot (mycetoma), chromomycosis, blastomycosis, coccidiomycosis (Coccidioides immitis), sporotrichosis (Sporothrix schenckii), granuloma trichophyticum (Trychophytum spp.), histoplasmosis (Histoplasma capsulatum)

Virus – Herpes zoster, herpes simplex, cytomegalovirus

Parasites – Leishmaniasis, Chagas` disease (Trypanosoma cruzi)

Vasculitis

Small vessel: leucocytoclastic vasculitis, microscopic polyangiitis, Wegener granulomatosis, Churg–

Strauss, HenochSchönlein purpura, essential cryoglobulinaemic vasculitis, erythema induratum Bazin, livedo reticularis, livedo vasculitis and Sneddon syndrome

Medium-sized: polyarteritis nodosa, Kawasaki disease

Haematological disorders

Sickle cell anemia, thalassaemia, hereditary spherocytosis, glucose-6-phosphate dehydrogenase deficiency, essential thrombocythaemia, thrombotic thrombocytopenic purpura, polycythaemia vera, monoclonal dysproteinaemia (Waldenström disease, myeloma), polyclonal dysproteinaemia (cryofibrinogenaemia, cold agglutinins)

Clotting disorders

Factor V Leiden, lupus anticoagulant, anticardiolipin (antiphospholipid syndrome), disturbed fibrinolysis, factor XIII deficiency, antithrombin III deficiency, protein C or S deficiency, disseminated intravascular coagulation, purpura fulminans

Metabolic disorders

Diabetes mellitus, necrobiosis lipoidica, porphyria cutanea tarda, gout, calciphylaxis, calcinosis cutis, hyperoxaluria,prolidase deficiency

Ulcerating tumors

Primary cutaneous neoplams (basal cell carcinoma, squamous cell carcinoma, malignant melanoma)

Cutaneous metastasis (solid tumors and lymphoproliferative diseases),

Malignant transformation of long standing ulcers (Marjolin ulcer)

Kaposi sarcoma

Drug reactions

Intralesional steroid injection, hydroxyurea, varfarin, cumarinic, heparin, vaccination (BCG), ergotamin, methotrexate, granulocyte-colony stimulating factor

Ulcerating skin diseases

Pyoderma gangrenosum, bullous diseases (bullous pemphigoid, pemphigus, bullous epidermolysis), panniculitis, periarteritis nodosa, erythema induratum (Bazin), erythema elevatum diutinum, Degos disease, sarcoidosis,  Behçet disease, cutaneous discoid and systemic lupus erythematosus, contact dermatitis, scleroderma, myxoedema, erythromelalgia, perniosis, haemangioma, reumathoid arthritis (Felty syndrome), Klinefelter  syndrome, lichen planus, pancreatic fat necrosis, insect bites, lymphoedema