Q I've had a venous ulcer on my ankle for some three months now, and hydrocolloidal bandages have not alleviated the almost constant pain. I'm 74 years old, in otherwise good health, and wonder whether I need complete rest, or whether I should do as much as I can (like gardening or fishing). - NW, Pembrokeshire
A Leg ulcers appear as shallow holes or craters in the skin. They may be extremely painful and, in some cases, give off an unpleasant smell. It is not unusual for such ulcers to remain unhealed for many years.
Among conventional treatments, none stands out as being effective:
* Antibiotics can create bacterial resistance, leaving ulcers unhealed.
* If wounds fail to heal, surgery may be advised. But this can result in unsightly scars.
* As contact sensitivity is usually the case in patients with leg ulcers, reactions to the 'inert' ingredients used in creams - lanolin, cetyl steryl alcohols, balsam of Peru and parabens - can make ulcers worse.
Venous ulcers are the most common type of leg ulcer, accounting for about 70 per cent of cases. Arterial and diabetic ulcers are also common. Although each involves a different mechanism, a common factor is often poor circulation.
Compression bandages, if fitted correctly, are one conventional approach that may help heal leg ulcers. Walking or any regular exercise will keep the calf muscle pumping blood efficiently. Stopping smoking and losing weight will also improve blood circulation. In addition:
* eat a high protein (24-per-cent) diet. This can help leg ulcers heal faster (J Am Geriatr Soc, 1993; 41: 357-62). Combined with a higher calorie intake, it may also avoid ulcer recurrence (Nutrition, 2000; 16: 1-5).
* increase antioxidants. The skin needs extra supplies to stay healthy. Taking 3 g/ day of vitamin C can speed up healing of leg ulcers due to thalassaemia (Br J Dermatol, 1975; 92: 339-41). Vitamin E applied to the skin will also help ulcers to heal (Pharmazie, 1993; 48: 772-5), as will daily use of the antioxidants diosmin (900 mg) and hesperidin (100 mg), or 150 mg/day of zinc (Int J Microbiol Clin Exp, 1997; 17: 21-6; Angiology, 1997; 48: 77-85; Lancet, 1969; i: 1264).
* include essential fatty acids to your supplementation regime. Evening primrose oil has been shown to improve blood flow to the legs and help heal leg ulcers (NZ Med J, 1986; 99: 552).
* try herbal remedies, such as topical aloe gel, applied daily with bandages (Int J Dermatol, 1973; 12: 68-73; Adv Wound Care, 1998; 11: 273-6), which may be more effective than plain hydrocolloidal bandages.
If your ulcer is severe, you might consider hyperbaric oxygen therapy, where you sit in a chamber filled with highly concentrated oxygen. This for five days a week for six weeks significantly helped healing in non-diabetic chronic leg ulcers (Plast Reconstr Surg, 1994; 93: 829-34).