Which type of ulcer is often described as being 'punched out' in appearance?

The appearance of a 'punched out' ulcer is characteristic of arterial ulcers. These ulcers typically result from inadequate blood supply due to arterial insufficiency, leading to tissue ischemia. Arterial ulcers often occur on the lower extremities, particularly around the toes, heels, or lateral malleolus. Their distinct 'punched out' quality is due to the clean, well-defined edges and a shallow depth, which contrasts with other types of ulcers that may have irregular borders or be more shallow and have varying depths.

In contrast, venous ulcers generally have irregular borders and are usually located around the medial malleolus, with a different appearance that does not reflect the 'punched out' description. Diabetic ulcers can also have various shapes and depths, often presenting as more shallow and having a different edge morphology. Pressure ulcers typically arise from prolonged pressure on the skin and have a different appearance, often leading to necrosis and more irregular margins. Thus, the distinctive 'punched out' appearance is primarily associated with arterial ulcers due to their underlying pathology.