Dermoscopic features of chronic leg ulcers and their correlation with clinical diagnosis

Background: An ulcer is an epidermal breach with or without the involvement of deeper tissues. Etiology can range from vasculopathy, neuropathy, infections, vasculitis, trauma, skin malignancies, and dermatological conditions such as pyoderma gangrenosum, necrobiosis lipoidica, and blistering disorders. Dermoscopy is an imaging technique enabling in vivo visualization of the epidermal surface. The device, being portable and user-friendly, has already slid into our routine practice as a non-invasive diagnostic tool. Aims and Objectives: This study aimed to describe the dermoscopy of chronic leg ulcers and correlate them with underlying etiology. Materials and Methods: The study included 40 clinically diagnosed chronic (>6 weeks) leg ulcers using a dermoscope (Dermlite DL4) presenting to the dermatology outpatient department in a tertiary care center in North India. Results: The average age was 41.8 years. The male: female ratio was 29:11. The most common cause was venous/stasis ulcer (30%), followed by mixed etiology (15%) and neuropathic (12.5%). Melanoma was rare. Dotted vessels were seen in 37.5% of cases, followed by pomegranate-like and glomerular vessels (27.5% and 25%, respectively). The background was red in 52.5% of cases; other features such as altered pigment network over surrounding skin (67.5%), white cicatrix (42.5%), thick white lines (35%), and keratin plugs (22.5%) were also observed. Conclusion: Dermoscopy is a relatively new tool in the field of dermatology that amplifies microscopic characteristics. This series attempts to study dermoscopic features of chronic leg ulcers and correlate them with clinical diagnosis. Further studies are required to validate these findings and design a dermoscopy-based triage algorithm for treatment and biopsy considerations in high-risk cases.