Neurogenic ulcer
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Synopsis

Neurogenic ulcers (also known as neuropathic and diabetic ulcers; mal perforans) will affect approximately 15% of individuals with diabetes during their lifetime. The pathogenesis of these ulcers is multifactorial and has to do with peripheral vascular disease, peripheral neuropathy, repetitive trauma, and mechanical change in the bony architecture of the foot over time. They occur over pressure points on the feet of individuals who have had diabetes for many years.
While the overwhelming majority of neurogenic ulcers occur in individuals with diabetes, any condition resulting in polyneuropathy (alcohol use disorder, arsenic poisoning, etc) or local neuropathy (eg, herpes zoster, Hansen disease) will predispose an individual to their formation.
Neurogenic ulcers are difficult to treat, frequently recur, and result in significant morbidity in the form of loss of function and, often, loss of limb.
While the overwhelming majority of neurogenic ulcers occur in individuals with diabetes, any condition resulting in polyneuropathy (alcohol use disorder, arsenic poisoning, etc) or local neuropathy (eg, herpes zoster, Hansen disease) will predispose an individual to their formation.
Neurogenic ulcers are difficult to treat, frequently recur, and result in significant morbidity in the form of loss of function and, often, loss of limb.
Codes
ICD10CM:
E13.621 – Other specified diabetes mellitus with foot ulcer
SNOMEDCT:
15074003 – Neurogenic ulcer
E13.621 – Other specified diabetes mellitus with foot ulcer
SNOMEDCT:
15074003 – Neurogenic ulcer
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Differential Diagnosis & Pitfalls
Keep in mind that many conditions that lead to skin ulceration may coexist within the same patient.
- Venous, or stasis, ulcer
- Arterial ulcer
- Vasculitis
- Pressure ulcer (decubitus ulcer)
- Pyoderma gangrenosum
- Acral lentiginous melanoma
- Necrobiosis lipoidica
- Calciphylaxis
- Basal cell carcinoma
- Squamous cell carcinoma / Marjolin ulcer
- Embolism
- Drug-induced cutaneous necrosis (Coumadin necrosis, heparin necrosis)
- Acroosteolysis
- Hereditary sensory neuropathy
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Last Updated:12/04/2019

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