Physical examination on a 65-year-old man with mild congestive hea failure reveals varicose veins, ankle edema, and inflammation of much of the skin near the ankles of both legs. The affected skin exhibits edema, erythema, mild scaling, and brown discoloration. The edges of skin involvement are poorly defined. On one ankle, a one centimeter diameter ulcerated area is seen within the erythematous area. The patient says that his leg lesions look much worse than they feel. Which of the following is the most likely diagnosis?
This is stasis dermatitis, which is a common complication of chronic lower leg edema, typically due to either congestive hea failure, venous incompetence, or both. The condition may be neglected by both the patient and the physician because of its relative lack of symptoms. However, it should be taken seriously because once skin breakdown occurs, the resulting ulcer may be very difficult to treat successfully. Helpful measures in the treatment of stasis dermatitis include elevating the ankles above the hea, properly fitted suppo hose, and tap water compresses. Ulcers are treated with compresses and bland dressings. Oral antibiotics are used when an ulcer becomes infected. Atopic dermatitis is an itchy inflammation of the skin that appears to have an allergic basis. Lichen simplex chronicus can also involve the ankles, but the lesion is very itchy, tends to be relatively localized, and is not typically accompanied by ankle edema. Seborrheic dermatitis causes diffuse scaling (dandruff) of the scalp. Ref: Suurmond D. (2009). Section 16. Skin Signs of Vascular Insufficiency. In D. Suurmond (Ed), Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, 6e.
Atopic dermatitis
Lichen simplex chronicus
Stasis dermatitis
Seborrheic dermatitis