A break in the continuity of the covering epithelium of the skin or mucous membrane is known as an ulcer. It may either follow the molecular death of the surface epithelium or its traumatic removal. Ulcers causes are as given following.


  • Traumatic causes, i.e.
    • Mechanical
    • Physical – electrical, radiation, etc.
    • Chemical
  • Vascular insufficiency, i.e.
    • Arterial
    • Venous
  • Neoplastic conditions
  •  Metabolic diseases -e.g. diabetes mellitus
  • Malnutrition, e.g.
  • Inflammatory processes, i.e.
  • Infective processes, i.e.
    • TB
    • Syphilis
    • Fungal infections
  • Neurogenic causes, e.g.
    • Bedsores
    •  Perforating ulcers
    •  Cord Lesions
    •  Peripheral Neuropathies
  • Other causes, i.e.


Etiological classification

  • Traumatic ulcers
traumatic ulcers causes
Traumatic ulcers
  •  Vascular ulcers
vascular ulcers
Vascular ulcers
  • Neoplastic ulcers
  •  Metabolic ulcers
  •  Ulcers due to malnutrition
  •  Inflammatory ulcers
  •  Infective ulcers
  • Miscellaneous ulcer

Clinical classification

  • Spreading ulcer i.e.-
    • Surrounding skin is inflamed
    • Floor is also covered by slough
    • No evidence of granulation tissue
    • Purulent discharge
spreading ulcer
Spreading ulcer
  • Healing ulcer i.e.-
    • Surrounding skin generally not inflamed
    • Floor also covered with granulation tissue
    • Edges hence show bluish outline of the growing epithelium
    • Slight serous discharge
healing ulcer
Healing ulcer
  • Callous ulcer i.e.-
    • Pale granulation tissue in the floor
    • Considerable induration at the base, edge and surrounding skin
    •  Show no tendency towards healing
callous ulcer
Callous ulcer

Pathological classification

  • Non-specific ulcers
  • Specific ulcers
  •  Malignant ulcers

Non-specific ulcers-

These include following:

  • Traumatic ulcers
  •  Arterial ulcers due to ischemia eg gangrene
  •  Venous ulcers e.g. Varicose ulcer
  • Neurogenic ulcers (i.e. trophic ulcer)
  • Ulcers associated with malnutrition Ulcers associated with other diseases e.g. Anemia, Avitaminosis, Gout, Rheumatoid arthritis
  • Miscellaneous ulcer

Specific ulcers-

These include following:

  • Infective ulcers e.g. syphilitic ulcers, Tuberculous ulcer, fungal ulcers, Buruli ulcer (a neglected tropical disease caused by infection with Mycobacterium ulcerans)

Malignant ulcers-

These include following:

  • Squamous cell carcinoma
  •  Basal cell carcinoma (i.e. rodent ulcer)
  • Malignant melanoma
  • Ulcerating adenocarcinoma


The natural history of an ulcer consists of three phases:

  • Extension phase
  • Transition phase
  •  Repair phase

Extension phase

  • The floor is basically covered with exudates and sloughs
  • The base is generally indurated
  • The discharge is thus purulent or even blood-stained

Transition phase

  • Prepares for healing
  • The floor thus becomes cleaner and the slough separates
  •  The induration of the base diminishes
  • The discharge hence become more serous
  • Small reddish area of granulation tissue appears on the floor

Repair phase

  • Transformation of granulation to fibrous tissue, which thus gradually contracts to form scar
  • The epithelium gradually extends from the new shelving edge to cover the floor (at a rate of 1mm/day)
  • The healing edge consists of three zones i.e. :
    • Outer zone-  This is white in color
    • Middle zone – bluish in color, granulation tissue covered by few layers of epithelium
    • Inner zone – Reddish in color, a zone of granulation tissue covered by a single layer of epithelial cells The red granulation tissue is due to increased density of new capillaries (neo-angiogenesis).


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