Which type of leg ulcer is typically punched-out with hair loss?

• A. Arterial
• B. Venous
• C. Diabetic
• D. Pressure

Answer: (A)

Arterial ulcers arise from reduced blood flow to the distal leg and foot. They classically present as punched-out, well-defined ulcers with hair loss around the lesion due to chronic ischemia thinning the skin and hair. The ulcer is often painful, the skin distal to it is cool and pale, and distal pulses are diminished or absent. This pattern distinguishes it from other leg ulcers: venous ulcers are usually irregular, occur near the medial ankle, and are associated with edema and venous changes; diabetic (neuropathic) ulcers typically occur on weight-bearing foot areas and may be painless with surrounding callus; pressure ulcers form over bony prominences from sustained pressure and have a different distribution and edge characteristics. So the punched-out appearance with hair loss points to an arterial insufficiency ulcer.