Leg ulcer in Sickle Cell Disorder

LEG ULCER IN SICKLE CELL DISORDER  

Leg ulcers are one of the most debilitating and stigmatizing complications of sickle cell disorder occurring in one ankle or both and can remain unhealed for several years. They are very painful, render the patients incapacitated, sometimes confined indoors and preclude them from leading normal, productive lives.

Leg ulcers are common in people with any kind of chronic inherited anaemia including SCD. They are not seen in children below the age of 12. The age group most affected is between 15 and 35 years. In West Africa, leg ulcers affect less than one in 15 adolescents and adult with sickle cell disorder.

Leg ulcers when they occur, are always situated near the prominent bones on the inside and the outside of the ankle. Usually, only one ankle is affected but occasionally both ankles are affected at the same time. The ulcers start without any obvious cause. Some patients report an earlier injury or blister, but this may simply be a coincidence, or just the first event in someone who would develop a leg ulcer in any case.

Treatment of leg ulcer

Many remedies have been tried to speed up the healing of leg ulcers. Sickle Cell Foundation Nigeria has identified a wound dressing solution that is more effective for sickle cell ulcers than commonly used solutions.

The following steps are recommended for leg ulcers patient:

  • Keep the leg(s) in a horizontal position as much as possible.
  • Clean the ulcer daily, dress it with sterile Vaseline gauze or solution and a bandage. The dressing protects the ulcer from getting infected.
  • Make sure the person is fully immunized against tetanus, as the ulcer could serve as an entry point for tetanus bacteria.
  • If the ulcer smells bad, it is infected. Ideally a swab should be taken and sent to the laboratory to identify the bacteria responsible. If this is not possible, the ulcer may be treated on the assumption that anaerobic bacteria are involved. The appropriate antibiotics may be taken by mouth and also applied to the ulcer.
  • If the ulcer is painful, an analgesic can be taken by mouth.