Dr Richard Bull, Dermatology Consultant, Homerton University Hospital and Barts Health, UK
Leg ulceration is a relatively uncommon complication of sickle cell disease but can be very disabling. Pathophysiology of leg ulceration is poorly understood but 2 groups seem to be identifiable; younger patients, especially men, developing ulcers which can be poorly responsive to physical therapies such as compression and a second group of slightly older men and women developing leg ulcers which respond to compression. The ulceration can worsen during sickle crises and is usually very painful. Ankle movement can be severely impaired along with gait. In patients within the UK wound infection does not seem to be as important as for patients in other parts of the world. Treatment has been of limited benefit and empirical to date with dressings, compression, medical therapy with hydroxycarbamide and exchange transfusion. Novel treatments such as nitric oxide may offer benefit.