Certain hemoglobinopathies may associated with skin ulcerations in the lower legs of the affected patient.


Hematologic disorders associated with leg ulcerations:

(1) sickle cell disease

(2) beta-thalassemia major

(3) sickle cell thalassemia

(4) hereditary spherocytosis


Features of skin ulcers in sickle cell disease:

(1) affects males more often than female

(2) onset 10-20 years of age, extending into adulthood

(3) more commonly seen in the Western Hemisphere (infrequent in Africa)

(4) The ulcers appear on the lower third of leg, usually above the medial or lateral malleoli.

(5) The lesion starts as small skin blister or infarct.

(6) The ulcer may appear punched out.

(7) The ulcer may be small or quite large and disabling.

(8) Pain is moderate.

(9) The lesion heals leaving a residual scar.


Differential diagnosis:

(1) Buruli ulcer or other infectious agents

(2) diabetes

(3) vasculitis

(4) pyoderma gangrenosum


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