Can I describe a long-standing ulcer with intermittent flares as an intermittent chronic ulcer?

Terminology for Long-Standing Ulcers with Intermittent Flares

Yes, you can describe a long-standing ulcer with intermittent flares as "chronic intermittent ulcer" or "chronic ulcer with intermittent activity," but the preferred terminology depends on the anatomical location and underlying etiology.

Established Terminology in Clinical Practice

For Gastrointestinal Ulcers

• In inflammatory bowel disease, "chronic pouchitis" specifically describes symptoms lasting more than 4 weeks, with subcategories including "chronic antibiotic-dependent pouchitis" (frequent episodes that recur days to weeks after antibiotic completion) and "chronic antibiotic-refractory pouchitis" (continuous or relapsing-remitting symptoms). 1
• "Acute pouchitis" (also called "intermittent pouchitis") is defined as episodes lasting less than 4 weeks that resolve fully with 2-4 weeks of antibiotic therapy, distinguishing it from chronic forms. 1
• The threshold for chronicity in gastrointestinal conditions is universally accepted as symptom duration exceeding 4 weeks, which applies to diarrhea, colitis, and ulcerative conditions. 1

For Cutaneous and Mucosal Ulcers

• Chronic ulcers are traditionally defined by etiology (internal pathophysiology) rather than duration alone, distinguishing them from acute wounds caused by external trauma. 2
• Chronic non-healing ulcers are specifically defined as skin defects that resist healing for more than 6 weeks, representing a distinct pathophysiological state characterized by persistent inflammation and impaired healing mechanisms. 3
• For oral ulcers, the classification system divides lesions into acute versus chronic based on presentation and progression, with chronic ulcers associated with conditions like lichen planus, pemphigus, and lupus that demonstrate persistent or recurrent patterns. 4

Appropriate Descriptive Terminology

When Describing Intermittent Patterns

• "Chronic ulcer with intermittent flares" or "chronic relapsing ulcer" accurately captures both the long-standing nature and the episodic pattern of symptom exacerbation. 1
• For gastrointestinal conditions, "relapsing-remitting" is the established term when complete remission occurs between episodes, as seen in chronic antibiotic-dependent pouchitis where symptoms recur after treatment cessation. 1
• The term "intermittent" alone (without "chronic") typically implies acute, self-limited episodes rather than a chronic underlying condition with periodic exacerbations. 1

Critical Distinction: Colonization vs. Active Disease

• In chronic wounds, distinguish between "colonization" (presence of microorganisms without tissue damage), "critical colonization" (delayed healing without overt infection), and "infection" (active tissue invasion), as these represent different stages requiring different management. 5
• Chronic ulcers are characterized by polymicrobial colonization in 90% of cases, with biofilm formation representing the primary virulence factor, making the distinction between colonization and active infection clinically crucial. 5

Key Clinical Caveats

Documentation Requirements

• Always specify the anatomical location (gastric, venous, pressure, oral) as this determines appropriate classification systems and treatment algorithms. 1, 6, 4
• Document the duration of individual episodes and the interval between episodes to differentiate between truly intermittent disease and chronic disease with incomplete remission. 1
• For venous ulcers specifically, note that they are "usually recurrent, and an open ulcer can persist for weeks to many years," making the distinction between continuous and intermittent patterns prognostically important. 6

Avoid Ambiguous Terms

• Do not use "indeterminate," "uncertain," or "unclassified" terminology unless diagnostic evaluation has been completed and no definitive etiology can be established, as these labels are reserved for inflammatory bowel disease without clear UC versus Crohn's differentiation. 1
• The term "chronic wound" implies delayed healing beyond expected timeframes (typically >6 weeks for cutaneous ulcers), not simply long duration, and carries specific pathophysiological implications regarding biofilm formation and impaired healing mechanisms. 3, 5