Some patients with severe hypertension may develop areas of ulceration on the lower extremities. These ulcers were first described by Martorell in 1945.


Key features:

(1)The lesion is a superficial ulceration on the lower extremity, often but not always on the anterolateral lower third of the leg.

(2) The lesion shows bilateral symmetry. The opposite side may be ulcerated or show an area of pigmentation.

(3) The lesion may show (a) episodic and irregular extension at the wound edges and (b) satellite lesions.

(4) The patient has a history of either poorly controlled or long-standing hypertension, often diastolic

(5) The ulcer may appear after a minor trauma.

(6) The patient experiences moderate to severe pain that is out of proportion to the size of the ulcer.

(7) It is more common in females than males.

(8) It is most often seen in patients ages 55-65.

(9) The ulcer is refractory to many ulcer therapies but often slowly heals over several months if the hypertension is adequately controlled.

(10) Other causes of ulceration (arterial insufficiency, venous insufficiency, diabetes, infection, rheumatologic disease, vasculitis, other) must be excluded


Biopsy shows hyalinization and thickening of the media in arterioles. One hypothesis is that these vessels of a high vascular resistance resulting in decreased skin perfusion.


To read more or access our algorithms and calculators, please log in or register.