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ULCERS AND CRUSTSUlcer/sIs ulcer/s on the leg?Blisters which dry to form honey coloured crusts.NoYes• If genital ulcer23.• If elsewhere onbody and noobvious causelike trauma, referto exclude skincancer.Impetigo likely• Usually starts on face, spreads to neck, hands, arms andlegs. May complicate bites or grazes.• May be extensive in HIV. If status is unknown test for HIV60.Check if foot pulses are present and if patient has muscle pain in legs orbuttocks on exercise.Foot pulses are present and no muscle pain in legs orbuttocks on exercise.Is there darkening of skin around the ulcer, varicoseveins and/or chronic swelling of the leg?No• If patient hasweight loss, coughor sweats, excludeTB 55.• Refer for furtherassessment.YesVenous stasis ulcer likely• Apply dressing undercompression (ideallyhydrocolloid dressing orsilver sulfadiazine cream).• Assess CVD risk 68.• Refer if patient hasdiabetes or ulcer nobetter after 1 month oftreatment.Foot pulses not presentand/or muscle pain in legsor buttocks on exercisePeripheral vasculardisease likely• Patient needs specialistassessment.• Do not applycompression bandageto ulcer/s.• 79.• Use aqueous cream to remove crusts.• Apply povidone iodine 5% cream 3 times a day.• Give amoxicillin 500mg 8 hourly for 5 days if extensiveinfection. If no response give flucloxacillin 500mg 6 hourlyfor 5 days. If penicillin allergic give erythromycin 500mg 6hourly for 5 days. If rash does not resolve completely, giveantibiotics for 5 days more.• Refer if no better after 10 days.46TB HIV CHRONIC RESPIRATORYDISEASECHRONIC DISEASESOF LIFESTYLEMENTAL HEALTH EPILEPSY MUSCULOSKELETALDISORDERSWOMEN'S HEALTH