Causes and effects of the chronic inflammation in venous leg ulcers

The pathogenesis of venous leg ulcers is multifactorial, In this review art icle new physiological, molecular and cellular abnormalities in venous ulce rs related to the chronic inflammation are presented and discussed. Venous hypertension causes disturbed microcirculation and pathological changes of the capillaries, which eventually locks the condition in a self-amplifying, detrimental cascade with persistent elevated levels and activities of pro- inflammatory cytokines and proteases preventing progress into a healing pha se, As a consequence fibroblasts senesce and become less responsive to grow th factors the older the ulcers become, Current data imply there is no defi ciency but rather an unfavorable distribution of growth factors in venous u lcers, An imbalance in proteolytic enzymes and their endogenous inhibitors is a common finding in chronic venous leg ulcers, Variation in disease seve rity and concomitant ailments in this heterogeneous patient group may expla in the contradictory results in the literature. Thus, to advance the areas of research further, longitudinal studies involving larger number of patien ts are required to identify the major pathogenic factors.