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70 yr old male with chronic itching lesion with ulceration ovet Left ankle for 1 week, he has applied povidone ointment ovrr the ulcer

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"venous leg ulcer" AND dermatitis

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venous leg ulcer clinical signs infection red flags management NICE

The photo is most consistent with an eczema-type lower-leg lesion with ulceration, possibly venous stasis dermatitis with a venous ulcer. The ankle-area location, surrounding brown discoloration, dry/scaly thickened itchy skin, and irregular shallow crusted ulcer support this. However, this cannot be confirmed from a photo.
In a 70-year-old, he needs an in-person wound and circulation assessment within 24 hours, preferably by a clinician with vascular/wound-care access. They should check:
  • Foot pulses, temperature, sensation, and capillary refill
  • Diabetes, smoking, varicose veins, leg swelling, past DVT, and medications
  • Ankle-brachial pressure index (ABPI) or Doppler before prescribing compression
  • Whether there is cellulitis/infection, arterial disease, or contact dermatitis from topical products
  • Need for wound cleaning/debridement and an appropriate dressing
Do not start compression stockings or tight bandaging until arterial circulation is assessed. Some ulcers are mixed venous-arterial, and compression can be unsafe in significant arterial disease. Venous ulcer care is based on treating venous hypertension with compression only after vascular assessment. NICE leg-ulcer pathway

Until he is assessed

  • Gently rinse with clean running water or normal saline, then pat dry.
  • Cover with a sterile non-adherent dressing. Do not pull off adherent crust.
  • Avoid scratching, friction from footwear, and prolonged standing.
  • Elevate the leg when resting, if comfortable.
  • I would stop repeated povidone-iodine application unless specifically advised by the treating clinician. It can irritate damaged eczematous skin and does not replace proper wound assessment and dressing selection.
  • Do not apply steroid cream, antibiotic cream, herbal remedies, or antiseptics directly into the open ulcer without examination.
  • Confirm tetanus vaccination status with the clinician.

Seek urgent care today, or emergency care if severe, if any of these occur

  • Spreading redness, warmth, swelling, increasing pain, pus, foul smell, fever, chills, or confusion
  • Rapid enlargement, black/grey tissue, bleeding, or severe pain
  • Cold, pale/blue foot, numbness, new rest pain, or absent pulses
  • New marked one-sided calf swelling or breathlessness
Antibiotics are generally used only when there are clinical signs of infection, not simply because an ulcer is present. Signs include increasing pain, heat, redness, swelling, purulent discharge, fever, malodour, or rapidly increasing exudate, as summarized in NICE infection guidance.
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