ABSTRACT
A 67-year-old man had a long history of hypertension, now controlled with angiotensin-converting enzyme inhibitor and diuretic therapy. The ulcer shown here developed on the lateral anterior shin and was extremely painful. Each of the following may be indicated in the care of this ulcer except:
a. Narcotic pain control b. Smoking cessation c. Excision d. Addition of a β-adrenergic blocker to the antihypertensive
regimen e. Skin grafting
• Described by Martorell in 1945
• Hypertensive ulcers are characteristically located in the lateral supramalleolar region of the lower extremities
• Characteristically, the ulcers have a punched-out appearance and serpiginous borders
• Ulcers result from small artery and arteriolar narrowing and occlusion
• The ulcers are often extremely painful
• A history of hypertension is the sine qua non of diagnosis, but the patient may be receiving treatment and be normotensive at presentation
• Peripheral vascular disease, edema, and stasis pigmentation are usually absent
• Antihypertensive therapy, smoking cessation, and pain control are important in the management of these ulcers
• Excision and skin grafting are often needed. Lumbar sympathectomy is sometimes needed to allow healing
• Addition of β-adrenergic blocker therapy is relatively contraindicated in patients with arteriolar ulcers. If βblocker therapy is being used, it should be stopped, if possible, to allow for maximal peripheral vasodilation
