# Venous leg ulcer - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: StatPearls: Venous Insufficiency Ulcers (NCBI Bookshelf NBK567802), Treatment / Management · Pentoxifylline extended-release tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID 9ca79c97-e4e5-4297-85eb-7a9b3d8083b5) · Paracetamol 500mg capsule shaped tablets SmPC section 4.2 (eMC product 12154) - Verified date: 2026-08 ## Verified against - StatPearls: Venous Insufficiency Ulcers (NCBI Bookshelf NBK567802), Treatment / Management - Pentoxifylline extended-release tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID 9ca79c97-e4e5-4297-85eb-7a9b3d8083b5) - Paracetamol 500mg capsule shaped tablets SmPC section 4.2 (eMC product 12154) - Venous Leg Ulcer - disease-level clinical article (venous-leg-ulcer-clinical.txt) ## Treatment metadata - Graduated compression therapy - Wound cleansing and simple dressing - Referral & safety-netting (no drug therapy) - Paracetamol — 500 mg — oral.solid - Pentoxifylline — 400 mg — oral.solid ## Complete treatment card ```text VENOUS LEG ULCER Sources: StatPearls: Venous Insufficiency Ulcers (NCBI Bookshelf NBK567802), Treatment / Management · Pentoxifylline extended-release tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID 9ca79c97-e4e5-4297-85eb-7a9b3d8083b5) · Paracetamol 500mg capsule shaped tablets SmPC section 4.2 (eMC product 12154) Review status: REVIEWED against StatPearls: Venous Insufficiency Ulcers (NCBI Bookshelf NBK567802), Treatment / Management, Pentoxifylline extended-release tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID 9ca79c97-e4e5-4297-85eb-7a9b3d8083b5), Paracetamol 500mg capsule shaped tablets SmPC section 4.2 (eMC product 12154), Venous Leg Ulcer - disease-level clinical article (venous-leg-ulcer- clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Itching, sometimes with an associated rash [itching · rash] - Aching pain over the lower medial leg (the gaiter area) - Ankle swelling that builds up over the day [leg swelling] - Cramping in the leg at night [muscle cramps] SIGNS - what you find (3) - Spider veins and small reticular veins mark the earliest stage of venous insufficiency [telangiectasia] - Brown-orange skin staining, chronic leg swelling, and hardened, tapered skin (lipodermatosclerosis) mark late disease [leg swelling] - Shallow, irregular ulcers with well-defined edges and fibrin on the base at the inner lower leg TESTS (5) - An ankle-brachial pressure index above 1 to 1.3 is considered normal; lower values grade severity and guide compression therapy - Roughly one in five patients with a venous ulcer also has coexisting arterial disease - An ABPI over 1.3 can reflect vascular calcification and warrants urgent vascular referral - Color duplex ultrasound detects venous reflux lasting more than 0.5 seconds - CT or MRI are used when deeper veins are difficult or impossible to assess on ultrasound IF NOT THIS - what else fits (4) - A deep, dry wound on the toes or foot with weak pulses and a cold limb points to an arterial ulcer instead - A deep, callused wound over a bony pressure point on the sole suggests a neuropathic or diabetic ulcer - An ulcer over the sacrum, heels, or hips in someone with limited mobility points to a pressure ulcer - Excess granulation tissue, raised edges, or failure to heal with standard care raises concern for skin cancer or pyoderma gangrenosum, and calls for biopsy Source StatPearls "Venous Leg Ulcer" - disease-level clinical article Status traced to the source above Rx: Compression | Wound care | Main treatment | Pain | Healing adjunct COMPRESSION 1. GRADUATED COMPRESSION THERAPY [1st line] Adult Compression is the treatment; everything else is an adjunct. Check the ankle-brachial pressure index FIRST. With ABPI 0.8 to 1.3, apply high compression, 23-35 mmHg at the ankle. If ABPI cannot be measured, mild compression up to 20 mmHg may be started once arterial disease has been ruled out clinically, with formal vascular assessment inside 4-6 weeks. Elevate the leg above hip level when sitting, and keep walking - Until healed, then lifelong compression hosiery - recurrence without it is the rule, not the exception Peds Leg ulceration in a child is not venous. It needs a diagnosis before it needs a dressing - sickle cell disease, vasculitis, pyoderma gangrenosum, infection, or non-accidental injury. Refer rather than treating it as an adult venous ulcer. Source StatPearls: Venous Insufficiency Ulcers (NCBI Bookshelf NBK567802), Treatment / Management Why Compression is the intervention the source puts at the foundation of treatment; everything else is adjunct. An ulcer treated with dressings and antibiotics but no compression is an ulcer being managed, not treated. Caution ABPI BEFORE COMPRESSION. High compression on an arterial leg causes necrosis. Below 0.8 is arterial or mixed disease and needs vascular assessment, not a bandage. Diabetes and rigid calcified vessels give a falsely high ABPI. A normal-looking index in a long-standing diabetic does not clear the leg. An ulcer that has not improved in 2 weeks of proper compression, or that has rolled or everted edges or exuberant granulation, needs a second look and a biopsy - a chronic ulcer can be a squamous carcinoma. WOUND CARE 2. WOUND CLEANSING AND SIMPLE DRESSING [1st line] Adult Clean with tap water or normal saline and cover with a simple non-adherent dressing. Debride slough where present. No dressing type has been shown better than another under compression, so choose on cost, comfort and how much exudate there is - Reassess at each dressing change Peds See the paediatric note above - refer rather than dress. Source StatPearls: Venous Insufficiency Ulcers (NCBI Bookshelf NBK567802), Treatment / Management Why Dressings are the part patients and clinicians spend most on and the part that changes the outcome least. The evidence sits with the compression underneath. Caution Do NOT give an antibiotic for a swab result. Every chronic ulcer is colonised. Systemic antibiotics are for clinical infection - a newly painful ulcer with spreading erythema, tenderness, warmth, or fever and chills. If that is present, treat as cellulitis; that entry carries the Egyptian regimens. Avoid topical antibiotics on a chronic ulcer. They drive resistance and contact sensitisation, and the surrounding skin is already prone to it. MAIN TREATMENT 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Venous Leg Ulcer - disease-level clinical article (venous-leg-ulcer-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - An ABPI > 1.3 indicates arterial wall calcification and requires urgent vascular specialist referral. RED FLAG - The absolute contraindications for compression therapy are arterial occlusive disease, ABPI < 0.5, severe uncontrolled hypertension, heart failure, deep thrombosis, and erysipelas. PAIN - give alongside 4. PARACETAMOL [add-on - not a substitute] Adult 500-1000 mg every 4-6 hours as needed, maximum 4000 mg daily - As needed Peds See the paediatric note above. Source Paracetamol 500mg capsule shaped tablets SmPC section 4.2 (eMC product 12154) Why Venous ulcers hurt, and the pain is the reason patients remove the compression that would heal them. Treating it is part of treating the ulcer. Caution Prefer paracetamol to an NSAID here. Many of these patients are elderly with heart failure or chronic kidney disease, and the oedema an NSAID causes works directly against the compression. Pain that is severe, or out of proportion, or worse when the leg is elevated, suggests arterial disease rather than venous. Reassess before adding analgesia and pressing on. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid HEALING ADJUNCT - give alongside 5. PENTOXIFYLLINE [add-on - not a substitute] Adult 400 mg three times a day with meals. Reduce to 400 mg twice daily (800 mg/day) if gastrointestinal or CNS side effects appear - Until the ulcer heals, reviewed at 6 months Peds Not for children; see the paediatric note above. Source Pentoxifylline extended-release tablets US prescribing information, DOSAGE AND ADMINISTRATION (DailyMed SetID 9ca79c97-e4e5-4297-85eb-7a9b3d8083b5) Why The source names pentoxifylline as an effective ancillary measure alongside compression. It is an add-on to compression, never a replacement for it, and it is the cheapest thing on this page - 400 mg SR from about 7.50 EGP for ten tablets. Caution OFF-LABEL for this. Pentoxifylline is licensed for intermittent claudication; using it to heal a venous ulcer is supported by the evidence in the cited chapter, not by the product licence. Say so if the patient asks. Bleeding and prolonged prothrombin time have been reported with pentoxifylline alongside NSAIDs, anticoagulants and antiplatelets. Monitor anticoagulation when starting or changing the dose. Avoid after recent cerebral or retinal haemorrhage. Egypt PENTOX 400MG SR 10 F.C.TAB HIKMA PHARMA ... 7.50 EGP (0.75/unit) NORMOBRAL 400 MG SR 20 F.C. TABS. SIGMA > TOP PHARM 17.00 EGP (0.85/unit) VASOTAL 400MG SR 20 F.C. TABS. UP PHARMA 22.00 EGP (1.10/unit) REBCOFLEX CR 400MG 20 F.C. TABS. ALFACURE PHAR... 22.50 EGP (1.12/unit) VASOCARE 400MG S.R. 20 TAB. OCTOBER PHARMA 74.00 EGP (3.70/unit) PENTAL 400MG 20 S.R.TAB. ALEXANDRIA 74.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)