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PubMed This is a summary of 26 peer-reviewed journal articles Updated
Hematology · Sickle Cell Leg Ulcers

How Are Sickle Cell Leg Ulcers Caused and Treated?

At a Glance

Sickle cell leg ulcers are slow-healing sores on the lower legs caused by poor circulation. Treatment involves specialized wound care, compression therapy to improve blood flow, and managing the underlying disease with transfusions or medication. Never use ice on these ulcers.

In this answer

3 sections

01

Why Do These Ulcers Happen?

02

How Are Leg Ulcers Treated?

03

Preventing Recurrence

Leg ulcers are a frequent, painful, and often recurring complication for people living with sickle cell anemia. Affecting up to 20% of people with the HbSS genotype [1][2], these sores usually appear on the lower legs and ankles. They are notoriously slow to heal—often taking many months to completely close—and can be incredibly frustrating. Because sickle cell disease affects your blood flow and oxygen delivery, standard wound healing is compromised. While there is no single “cure-all” for these ulcers, a combination of targeted wound care, therapies aimed at the underlying disease, and preventative measures can help heal existing sores and keep them from coming back.

Why Do These Ulcers Happen?

Sickle cell leg ulcers are not caused by typical injuries, though a small scrape or bug bite can trigger them. Instead, they happen because of the underlying changes in your blood and blood vessels:

  • Poor Circulation (Vasculopathy): The rigid, sickle-shaped red blood cells can slow down or block blood flow in the tiny blood vessels of your legs [3][4]. When skin tissue is starved of oxygen and nutrients, it breaks down and has a very hard time repairing itself.
  • Chronic Hemolysis: Sickled red blood cells break down much faster than normal cells, a process called hemolysis. This constant breakdown releases substances into your blood that damage the lining of blood vessels (endothelial dysfunction) [5]. Blood tests often show signs of this, such as higher bilirubin and lower hemoglobin levels, which are strong risk factors for developing ulcers [5][6].
  • Skin Barrier Genetics: Recent research suggests that some people with sickle cell have genetic variations, such as in a gene called FLG2, which makes their skin barrier naturally weaker [7][8]. This makes the skin more vulnerable to inflammation and less able to fight off infections.

How Are Leg Ulcers Treated?

Currently, there are no universally standardized, step-by-step guidelines for treating sickle cell leg ulcers, so your medical team will tailor an approach specifically to you [9][10]. Healing requires patience and a multi-layered strategy:

1. Direct Wound Care

  • Wound Bed Preparation: The first step is keeping the ulcer clean and removing dead tissue, which provides a healthy foundation for new skin to grow [11]. Your doctor will give you specific instructions on how to shower with the wound and what dressings to use to keep it protected.
  • Topical Therapies: Depending on the ulcer, your doctor may recommend specific dressings or topical treatments. Specialized options like medical-grade honey or transdermal oxygen therapy have shown promise in some cases [12][13]. Another advanced option is using a bovine collagen matrix, which provides a structural framework to help your own skin cells regenerate [14].

2. Compression Therapy

Compression therapy is widely considered a foundational treatment for both healing ulcers and preventing them from returning [11][10]. Using specially fitted compression stockings or bandages helps push pooled blood back up the legs towards the heart, reducing swelling and improving circulation to the skin [15][16]. Safety Note: Your doctor will likely need to test your arterial blood flow before prescribing compression therapy to ensure it is safe for your blood vessels.

3. Systemic (Body-Wide) Treatments

Because the root cause is in your blood, treating the ulcer often requires managing your sickle cell disease more aggressively.

  • Blood Transfusions: Regular transfusions of healthy, normal red blood cells (HbA) can improve oxygen delivery to the wound and speed up healing [12][17].
  • Medications: Some early evidence suggests supplements like arginine may help improve blood vessel function [18]. If you take hydroxyurea, a common disease-modifying therapy for sickle cell disease, its relationship with leg ulcers can be complex. Current evidence does not consistently associate its use with the healing or prevention of leg ulcers, and it may need to be evaluated by your care team [19].

Managing Pain and Infection

Leg ulcers are extremely painful. Work closely with your doctor to create a safe pain management plan, as some over-the-counter pain relievers can affect your kidneys.

  • What NOT to do: You should never use ice or topical cryotherapy to numb the area [20]. Cold temperatures constrict blood vessels, further cutting off the blood supply and making the ulcer worse.
  • Watch for Infection: Because your skin barrier may be compromised [7], watch for signs of infection such as spreading redness, warmth, a foul odor, yellow or green pus, or fever. If you experience these, seek medical attention immediately.

Preventing Recurrence

Unfortunately, even after a sickle cell ulcer heals, the risk of it returning is very high [9][21]. Long-term prevention is just as important as acute treatment.

  • Protect Your Skin: Avoid trauma to your lower legs. Wear long pants and protective, well-fitting shoes. Even minor scratches or insect bites can turn into ulcers [22][23].
  • Wear Compression Stockings: Wearing compression stockings daily, even after the ulcer heals, is one of the most effective ways to support circulation and prevent new sores [15][24].
  • Manage Your Overall Health: Work with your hematologist to optimize your blood counts and reduce hemolysis [25]. Self-management and patient education on skin protection are crucial to maintaining healed skin [23][26].

Common questions in this guide

Why do people with sickle cell get leg ulcers?
Sickle cell leg ulcers happen because rigid, sickled red blood cells slow down or block blood flow in the tiny vessels of your legs. This lack of oxygen and nutrients causes the skin tissue to break down and makes it difficult for the body to repair the area.
Can compression socks help sickle cell leg ulcers?
Yes, compression therapy is a foundational treatment for healing and preventing leg ulcers because it pushes pooled blood back toward the heart to improve circulation. However, your doctor must check your arterial blood flow first to ensure compression is safe for your blood vessels.
Should I use ice to numb the pain of a sickle cell ulcer?
You should never use ice or cold therapy on a sickle cell leg ulcer. Cold temperatures constrict your blood vessels, which cuts off the vital blood supply to the skin and can make the wound much worse.
What are the signs that my leg ulcer is infected?
Signs of infection include spreading redness, warmth around the wound, a foul odor, yellow or green pus, or a fever. If you notice any of these symptoms, you should seek immediate medical attention, as your skin barrier is compromised.
How can I prevent sickle cell leg ulcers from coming back?
To prevent recurrence, protect your lower legs from trauma by wearing long pants and well-fitting shoes. Wearing compression stockings daily and working with your hematologist to manage your overall sickle cell disease can also help keep your skin healthy.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Is a wound care specialist part of my care team, and do they have experience specifically with sickle cell leg ulcers?
  2. 2.Am I a candidate for compression therapy, and how will we test if my arterial blood flow is strong enough to handle it safely?
  3. 3.How does my current sickle cell medication, such as hydroxyurea, affect my ulcer healing?
  4. 4.Would starting or increasing blood transfusions help my ulcers heal faster?
  5. 5.What are the warning signs of infection in my ulcer that should prompt an immediate call or visit to the clinic?

Questions For You

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References

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This page provides informational guidance on managing sickle cell leg ulcers. Always consult your hematologist or wound care specialist before starting new treatments, especially compression therapy.

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