Histopathological spectrum of chronic skin ulcers in a tertiary care hospital

Imza Feroz, Abdul Haseeb Wani, Mir Wajahat Un Nazir, Mohammad Iqbal Lone, Arshed Hussain Parry


Background: The skin is the largest organ of the body, comprising of epidermis, dermis and hypodermis. Thus, a wide range of diseases can develop from the skin ranging from infectious diseases to malignancy, some of which may present as non-healing ulcers. Skin biopsy forms the fundamental basis for differentiation of similar looking lesions, thus helping the pathologists to make a definitive diagnosis and more so to the clinician for better management of patients. The objective was to study the histopathological spectrum of chronic non healing ulcers of skin for proper management and treatment.

Methods: This was a hospital-based study which was conducted in SKIMS, Soura, a tertiary care hospital of Kashmir valley for a period of 1 year extending from January 2018 to December 2018. All the patients who presented with the complaint of non-healing ulcer for more than 4 to 6 weeks were subjected to skin biopsy and histopathological examination.

Results: A total of 260 biopsies were examined. Out of 260 patients 146 were males and 114 were females. Ninety out of 260 cases (34.61%) and 170 (65.39%) were diagnosed as malignant and benign ulcers respectively.

Diabetic ulcer was the second most common cause of non-healing ulcers followed by bacterial infections and tuberculosis. Squamous cell carcinoma was the most common neoplastic pathology.

Conclusions: It was concluded from the study that non-healing skin ulcers can be encountered at any age in daily medical practice.


Diabetic neuropathic, Skin biopsy, Non-healing ulcer, Squamous cell carcinoma, Malignant melanoma, Xeroderma pigmentosum

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Achalkar GV. Clinico-pathological evaluation of non-neoplastic and neoplastic skin lesions: A study of 100 cases. Indian J Pathol Oncol. 2019;6:118-22.

General Surgery Referral Guidelines, Madigan Army Medical Centre, Tacoma, Washington-98431.

Sebastian KMS, Lobato I, Hernandez I, et al. Efficacy and safety of autologous platelet rich plasma for the treatment of vascular ulcers in primary care: phase III study. BMC Fam Pract. 2014;15:211.

Greer N, Foman NA, MacDonald R, Dorrian J, Fitzgerald P, Rutks I, et al. Advanced wound care therapies for non-healing diabetic, venous, and arterial ulcers: a systematic review. 2012;159(8):532-42.

Martinez-Zapata MJ, Martí-Carvajal AJ, Solà I, Expósito JA, Bolíbar I, Rodríguez L, et al. Autologous platelet rich plasma for treating chronic wounds. Cochrane Database Syst. 2012;10:CD006899.

Grossman MC, Silvers DN. The Tzanck smear: Can dermatologists accurately interpret it? J Am Acad Dermatol. 1992;27:403-5.

Tzanck A. Le cytodiagnostic immediate end dermatology. Ann de Dermat Et Syph. 1947;7:68.

Sturm AW, Jamil B, Mc Adam KPWJ, Khan KZ, Parveen S, Chian T, et al. Microbial Colonizers in leprosy skin ulcers and intensity of inflammation. Int J Lepr 1996;64:274-81.

Robinson DC, Hay RJ. Tropical Ulcer in Zambia. Trans R Soc Trop Med Hyg. 1986;80:1432-7.

Lautenschlager S, Eichmann A. Differential diagnosis of leg ulcers. In: Hafner J, Ramelet A-A, Schmeller W, Brunner UV, eds. Management of leg ulcers. Current Problems in Dermatology, vol. 28. Basel, Switzerland: Karger: 1999: 257-270.

Zeegelar JE, Faber WR. Imported tropical infectious ulcers in travelers. Am J Clin Dermatol. 2008;9:219-32.

Zeegelar JE, Stroink AC, Steketee QH, Faber WR, Vanderwal AC, Komolafe IOO, et al. Etiology and incidence of chronic ulcers in Blatyre, Malawi. Int J Dermatol. 2006;45(8):933-6.

Saraf SK, Shukla VK, Kaur P, Pandey SS. A clinico-epidemilogical profile of non healing wounds in an Indian hospitals. J Wound Care. 2000;9(5):247-50.

Mekkes JR, MCoots MA, Van Der Wal AC, Bos JD. Causes, investigation and treatment of leg ulceration. Br J Dermatol. 2003;148: 388-401.

Baba IQ, Wani LA, Farooq S, Amin J, Imtiyaz S, Ahmed H. Histopathological evaluation of chronic non healing ulcers of skin in patients referred to tertiary care hospitals in Kashmir. Int J Adv Res. 2018;6:1885-90.

Laishram RS, Banerjee S, Punyabati P, Durlar L, Sharma C. Pattern of skin malignancies in Manipur in India: A 5 years histopathological review. J Pak Assoc Dermatol. 2010;20:128-32.

Neil HAW, Thompson AV, Thorgood M et al. Diabetes in the elderly, the oxford university diabetes study. Diabetic Med. 1989;6:608-13.

Nyamu PN, Otieno CF, Amayo EO, McLigyeo SO. Risk factors and prevalence of diabetic foot ulcers at Kenyatta. National Hospital. Nairobi-East African Med J. 2003;80:36-43.

Erikson G, Eklund AE, Leallings LO. Clinical significance of bacterial growth in venous leg ulcers. Scandinavian J Infect Dis. 1984;16(2):175-80.

Gaur DS, Verma A, Gupta P. Diabetic foot in Uttaranchal. J K Sci. 2007;9(1):18-20.

Bansal E, Garg A, Bhatia S, Attri AK, Chader J. Spectrum of microbial flora in diabetic foot ulcers. Indian J Pathol Microbiol. 2008;51:204-8.

Giacometti A, Cirioni O, Schimizzi AM, Prete MS Del, Barchiesi F, Errico MMD, et al. Epidemiology and Microbiology of Surgical wound infections. J Clin Microbiol. 2000,38;2:918-22.

Paltrey DC, Rhodes B, Chatwood JG. Investigation into microbial flora of healing & on healing decubitus ulcers. J Clin Pathol. 1981;34:701-5.

Padmavathy L, Rao LL, Pari T, Ethirajan N and Swamy BK. Lupus vulgaris and tuberculosis verrucosa cutis - A clinical, pathological, epidemiological study of 71 cases. Indian J Tuberc. 2008;55:203-9.

Naved uz Zafar M, Memon MA, Asha MA, Shaheen, Agha A, Hashim Y, et al. Pattern of cutaneous tuberculosis as identified by morphological study of skin lesions at Jinnah Postgraduate Medical Center, Karachi. Gomal J Med Sci. 2010;8:1.

Kumar B, Muralidhar S. Cutaneous tuberculosis: a twenty year prospective study. Int J Tuberculosis Lung Dis 1995;3:494-500.

Sehgal VN, Srivastava G, Khurana VK. An appraisal of epidemiological, clinical, bacteriologic, histopathologic and immunologic parameters in cutaneous tuberculosis. Int J Dermatol. 1987;26:521-6.