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Martorell hypertensive leg ulcer
Other Resources UpToDate PubMed

Martorell hypertensive leg ulcer

Contributors: Catherine J. Wang, Susan Burgin MD
Other Resources UpToDate PubMed


Martorell hypertensive leg ulcer is a painful ischemic ulcer on the lower extremity caused by long-standing, uncontrolled hypertension. Many patients also have diabetes mellitus. This condition was previously thought to affect women aged 50-70 years, but an older mean age and lack of female predominance have been described in more recent studies.

Martorell ulcer is thought to be due to subcutaneous arteriosclerosis that develops as a result of increased peripheral vascular resistance occurring in the setting of chronic hypertension. This leads to diminished arteriolar blood flow to the skin, followed by ischemia and ulceration.

Martorell ulcers are often underdiagnosed: a prospective cohort of 59 patients demonstrated a mean duration before diagnosis of 11 weeks and the wound extending to a mean surface area of 19 cm.

Related topic: Ischemic ulcer


L97.909 – Non-pressure chronic ulcer of unspecified part of unspecified lower leg with unspecified severity

238795008 – Hypertensive leg ulcer

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Differential Diagnosis & Pitfalls

  • Pyoderma gangrenosum – May be difficult to distinguish. A deep wedge biopsy can correctly diagnose a Martorell ulcer, whereas superficial biopsies may demonstrate inflammatory cell infiltrates and lead to an incorrect diagnosis of pyoderma gangrenosum.
  • Calciphylaxis – Associated with chronic renal failure or secondary hyperthyroidism.
  • Necrotizing vasculitis (see Vasculitis, Polyarteritis nodosa) – Purpuric lesions, usually bilateral.
  • Sickle cell disease
  • Stasis ulcer – Shallow with granulation tissue base.
  • Ischemic ulcer – Associated with peripheral artery disease; often presents on anterior shin with a deep, punched-out appearance.
  • Cutaneous squamous cell carcinoma

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Last Reviewed:02/20/2019
Last Updated:03/04/2019
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Martorell hypertensive leg ulcer
A medical illustration showing key findings of Martorell hypertensive leg ulcer : Painful skin lesions, Hypertension, Lower limb
Copyright © 2024 VisualDx®. All rights reserved.