Venous leg ulcer — SCE Dermatology MCQ

Correct answer: A — Multilayer compression bandaging with simple dressing

The correct answer is A, multilayer compression bandaging with simple dressing. The clinical picture (medial malleolar ulcer, oedema, varicose eczema, haemosiderin staining, palpable pulses) is classic for venous ulceration due to chronic venous hypertension, and an ABPI of 0.94 confirms adequate arterial inflow with no significant arterial disease. Compression is the definitive treatment because it reduces ambient venous pressure and improves healing rates, and current UK guidance states it should be offered to all people with non-infected venous leg ulcers who have an ABPI of 0.8 or higher. A simple, low-adherence dressing is used underneath the bandaging mainly for exudate management and comfort rather than to drive healing itself. Why the other options are wrong: E. Topical fusidic acid under occlusion: there is no spreading cellulitis or other sign of clinical infection, so topical or systemic antibiotics are not indicated and antibiotic overuse promotes resistance without improving healing. B. Urgent arterial revascularisation referral: an ABPI of 0.94 is within the normal range (0.8 to 1.3), excluding significant peripheral arterial disease, so arterial referral is unnecessary and compression is safe. D. High-dose oral prednisolone: the ulcer and surrounding changes are due to venous hypertension, not an inflammatory or autoimmune dermatosis, so systemic steroids have no role and would impair wound healing. C. Daily povidone-iodine wet dressings: antiseptic wet dressings do not correct the underlying venous hypertension driving the ulcer and are not recommended as a primary therapy; they may also cause local irritation or delayed healing with prolonged use. Key point: In a venous leg ulcer with ABPI 0.8 or above, multilayer compression bandaging is the cornerstone treatment because it directly treats the venous hypertension causing the ulcer.

Reference: NICE, Compression therapy for venous leg ulcers (based on NICE CKS: Leg ulcer - venous), 2022, https://www.nice.org.uk/advice/mib140/chapter/The-technology