Leg Ulcers and Sickle Cell Disease

Reviewed by: HU Medical Review Board | Last reviewed: January 2021

People with sickle cell disease (SCD) may develop leg ulcers because of poor blood circulation in the leg. Some ulcers will heal quickly, while others may last for a long time. Leg ulcers are often very painful for people with SCD.

Leg ulcers are linked to other complications of SCD. If you show symptoms of leg ulcers, talk to your doctor. They can advise you on lifestyle changes to help prevent ulcer formation. They can also determine how to treat them to avoid serious complications.

What are leg ulcers?

Ulcers are sores or wounds on the skin caused by poor blood circulation. They usually happen on the lower part of the leg, above the ankle. They usually progress in stages, getting larger and deeper into the skin.1,2

Leg ulcers can either be acute or chronic. An acute ulcer may heal in less than a month. However, chronic ulcers often last for 6 months or even many years. Chronic ulcers can close and reopen many times over this period.1

Leg ulcers are caused by many medical conditions that affect blood flow in the leg, including SCD. People with SCD tend to experience a type of leg ulcer called venous ulcers. These are ulcers caused by venous stasis, which is a slow blood flow.2

People with SCD and leg ulcers may have a higher risk of developing other complications. These include:1,3

  • Pulmonary hypertension (high blood pressure in the lungs)
  • Priapism (painful erections)
  • Kidney disease
  • Anxiety due to physical appearance, especially in adolescence

Why does sickle cell disease cause them?

We do not yet know exactly how SCD causes leg ulcers. A number of different factors probably contribute to leg ulcer formation, such as:1,4

  • Blockage of blood vessels by sickled red blood cells
  • Bacterial infections
  • Anemia because of bursting sickled red blood cells
  • Blood vessel narrowing
  • Injury or trauma

Leg ulcers are more common in men and usually do not appear until after age 10. People with sickle cell anemia (HbSS) have a higher risk of leg ulcers than people with other types of SCD. The rate of leg ulcers varies around the world. In tropical regions like Jamaica, leg ulcers affect 75 percent of people with HbSS. However, only 1 out of every 10 people with HbSS in North America develops leg ulcers.1

What are the symptoms?

Common symptoms of leg ulcers for people with SCD include:1,2

  • Pain, which may be severe, sharp, or stinging
  • Red wound covered with yellow tissue
  • Green or yellow discharge, if infected
  • Discolored, swollen, and warm skin around the ulcer
  • Itchy or burning feeling

If you begin to see symptoms of leg ulcers, talk to your doctor. They can help treat the ulcer and prevent new ulcers from forming.

How can they be prevented or treated?

Injuries and trauma are common triggers of leg ulcers. Avoiding situations that could cause leg injuries may help prevent leg ulcers. Compression stockings can also prevent the formation of new ulcers.1

Lifestyle changes that improve blood circulation may help to prevent and treat blood ulcers. This includes:5

  • Hydration and eating a healthy diet
  • Moderate exercise
  • Avoiding smoking
  • Maintaining a healthy weight

There is no evidence that hydroxyurea or blood transfusions can prevent or treat leg ulcers. Treatment usually focuses on preventing infection, controlling swelling, and easing pain. This may include:1,2

  • Topical antibiotics
  • Pain medications
  • Elevation of the leg or bed rest
  • Surgical or medical removal of damaged or dead tissue
  • Compression therapy
  • Topical application of medication with growth factors
  • Skin grafts

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