What are the other Names for this Condition? (Also known as/Synonyms)

• Arteriosclerotic Ulcer of Martorell
• Martorell Hypertensive Ischemic Leg Ulcer (Martorell HYTILU)
• Necrotic Angiodermatitis

What is Martorell Ulcer? (Definition/Background Information)

• Martorell Ulcer is an uncommon and painful ulcer on the lower leg that is particularly seen in middle-aged and older women arising from chronic and poorly-controlled systemic hypertension (high blood pressure)
• Martorell’s Ulcer do not respond to topical ointments and creams. The treatment involves managing the underlying hypertension and undertaking appropriate wound care. The prognosis is typically good with adequate treatment

Who gets Martorell Ulcer? (Age and Sex Distribution)

• Martorell Ulcer is a rare complication that is usually observed in adults. Even though most cases are observed in individuals between ages 50 and 60 years, an age range of 41-86 years is reported
• Both males and females are affected; however, women are predominantly affected than men
• Worldwide, individuals of all racial and ethnic groups may be affected

What are the Risk Factors for Martorell Ulcer? (Predisposing Factors)

The risk factors for Martorell’s Ulcer include:

• Uncontrolled and longstanding hypertension - it is the single most important risk factor
• Middle-aged and older women have a high risk for the condition
• Type 2 diabetes: An association is noted with poorly-controlled diabetes

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Martorell Ulcer? (Etiology)

• Martorell Ulcer forms from obstruction of blood flow to the small blood vessels in the lower limbs leading to ischemia, skin destruction, and ulceration
• It is described as a form of peripheral arterial vascular disease, occurring from chronic arterial hypertension that is poorly controlled

What are the Signs and Symptoms of Martorell Ulcer?

The signs and symptoms of Martorell Ulcer may vary among the affected individuals. These include:

• Presence of very painful ulcerative lesions in the lower leg (behind and below the knee, above the ankle)
• Even small lesions may present severe pain
• Martorell Ulcer may begin as small blister(s) that may or may not be the result of any skin injuries
• The blisters turn into reddish patches that ulcerate with time
• More than a single ulcer may be observed; in some cases, a large ulcer with small satellite lesions may be observed around it
• These hypertensive ulcers are deep and present irregular edges with a necrotic base
• Inflammation around the ulcer is noted
• Sometimes, solitary ulcers forms symmetrically on both the right and left legs
• Resting or keeping the leg elevated is not known to decrease pain intensity
• Application of topical creams and ointments is mostly ineffective

How is Martorell Ulcer Diagnosed?

The following tests and procedures may be performed to diagnose Martorell Ulcer:

• Complete physical examination and a thorough medical history evaluation (including personal medical history of high blood pressure and diabetes)
• Complete blood count (CBC), antibody test, C-reactive protein test, and tissue culture studies, as necessary
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Martorell Ulcer?

Complications in Martorell Ulcer may include the following:

• Development of secondary infections
• Emotional stress
• Cosmetic concerns; concerns of scarring
• Chronic pain
• Abscess formation
• Need for extensive treatments since the ulcers do not respond well to topical therapy

How is Martorell Ulcer Treated?

Martorell Ulcer is managed in the following manner:

• Administration of painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) and opioids (for extremely severe pain)
• Antihypertensive therapy using medications to control/decrease vasoconstriction, which include beta-blockers and ACE inhibitors
• Wound care that may include wound cleaning, surgical debridement, hyperbaric therapy, and skin grafting, if necessary
• For any superimposed bacterial infections, antibiotics may be administered

Periodic monitoring or follow-up of the condition with the healthcare provider is recommended.

How can Martorell Ulcer be Prevented?

The preventative measures for Martorell Ulcer may include:

• Leading a healthy lifestyle and keeping high blood pressure under control; regularly taking the prescribed medications
• Controlling diabetes
• Losing weight if one is obese or overweight
• Avoiding any trauma to the legs
• Smoking cessation
• Wearing compression stockings (especially women at high risk)

What is the Prognosis of Martorell Ulcer? (Outcomes/Resolutions)

• The prognosis of Martorell Ulcer depends on the severity of the signs and symptoms, response to treatment, and the overall health status of the individual
• In many, the prognosis is good with adequate treatment, and the lesions are known to heal well. However, individuals with poor immune status may have unfavorable outcomes

Additional and Relevant Useful Information for Martorell Ulcer:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/