An Elderly Man with Leg Pain and Chronic Rash
An 82-year-old white man with a medical history significant for hypertension, type 2 diabetes mellitus, hyperlipidemia, coronary artery disease, and noncompliance with medications and office visits presents to an outpatient clinic with a several-year history of intermittent bilateral leg pain, edema, pruritus, and bilateral lower extremity color changes. The patient works as a cashier and stands for much of the day. He reports worsening symptoms for the last 6 months, but denies any exertional pain, fever, chills, numbness, or tingling. On examination, he does not have any skin breakdown and he is found to have 2/4 pedal pulses.
Based on the case description and the photograph above, what is your diagnosis?
A. Stasis dermatitis
C. Dermatitis from arterial insufficiency
D. Neuropathic dermatitis
Answer and discussion on next page