Study Characterizes Sickle Cell-Associated Leg Ulcers in Women

The presentation of leg ulcers is one of many complications associated with sickle cell disease (SCD). It can affect individuals of either sex, starting acutely and progressing to chronic phases.

A new retrospective study, led by investigators from the Federal University of Minas Gerais, Brazil, characterized a group of women presenting with leg ulcers, particularly noting their demographics, ulcer presentations, and outcomes.

“The interaction between people with ulcers and health professionals is an essential element in the definition of care,” the investigators wrote.

“In this context,” they continued, “knowledge of the profile of women with leg ulcers due to SCD is important because it is a population that already has complications and concerns that are characteristic of this gender, such as planning reproductive life, pregnancy complications, as well as the care of a child with SCD.”

Leg Ulcers in Women: A Small Cohort

The cohort study included patients (n = 17) from a dermatology outpatient clinic in a tertiary university hospital in Minas Gerais, Brazil, had SCD and leg ulcers, and were ≥18 years of age.

The team collected data from June 2020-August 2020, which consisted of pertinent information derived from patient medical records.

As such, between June 1998-June 2014, 17 women were admitted for leg ulcers due to SCD. Of this total, 11 reached complete ulcer epithelization, 3 were transferred to other services, 2 abandoned treatment, and 1 patient died.

Many of the women were aged 30-39 years of age (n = 10), self-identified as brown (n = 11), were single (n = 12), had an income of 2-3 minimum wages (n = 9), and had an incomplete elementary education (n = 7).

Furthermore, 13 of the women had no associated diseases, 12 were eutrophic, and 14 used vitamin supplements.

There was a total of 29 leg ulcers across all evaluated women — 12 of whom presented ulcers in the medial malleolus, 9 in the right lateral malleolus, and 8 in the lower third of the leg.

The team also reported that 9 women only had 1 ulcer, 6 had 2 ulcers, and 2 and 4 ulcers. All ulcers were classified as stage 3.

“Among the participants in this study who obtained a cure, 31.03% required 2 to 4 months, with appropriate topical treatment and edema control, according to the recommendations for the management of leg ulcers in people with SCD,” the investigators wrote.

For a majority of women (n = 16), some of their leg ulcers lasted from 2-36 months, with other leg ulcers lasting >96 months for some patients (n = 6).

Topical treatments included use of coverings, such as hydrocolloid plaque, calcium alginate, activated carbon with Ag and polyurethane foam with Ag. Edema was managed with the Unna boot.

Conclusion and Looking Ahead

The investigators acknowledged limitations with the small sample size, although they expressed hope that their findings will generate further discussion surrounding leg ulcers in the female population

Ongoing research has shown that new therapeutics—such as voxelotor— may signficiantly improve leg ulcers in all affected patients. 

According to a recent post-hoc analysis of the HOPE trial, improvements were reported as early as 24 weeks into treatment.

And yet, as implied in the above study, there is a continued need to further investigate presentations and outcomes of these sickle cell complications in specific populations.

The study, “Profile Of Women With Leg Ulcers Due To Sickle Cell Disease,” was published online in Brazilian Journal of Enterostomal Therapy.