A 50-year-old nurse consults a physician because of a rash above both her ankles

A 50-year-old nurse consults a physician because of a rash above both her ankles. Physical
examination demonstrates marked ankle edema with erythema, mild scaling, and brown
discoloration of the overlying skin of the distal lower legs. Varicose veins are also noted. Which
of the following is the most likely diagnosis?

A. Atopic dermatitis
B. Cellulitis
C. Lichen simplex chronicus
D. Nummular dermatitis
E. Stasis dermatitis


The correct answer is E. This is stasis dermatitis, which is a persistent inflammation of the skin
of the lower legs. The condition is often related to varicose veins, although it has been postulated
that the true cause may instead be perivascular fibrin deposition and abnormal small vessel
vasoconstrictive reflexes. The presentation illustrated is typical. Most patients are relatively
asymptomatic and may not seek medical attention until the edema becomes severe or the lesions
become complicated by secondary bacterial infection or ulceration. It is important to increase the
venous return to the heart by elevating the ankles while resting and use of properly fitted support
hose. Local topical tap water compresses can be helpful. Purulent lesions can be treated with
hydrocolloid dressings. Ulcers are treated with compresses and bland dressings, such as zinc
oxide paste.
Atopic dermatitis (choice A) typically involves the antecubital and popliteal fossas, eyelids,
neck, and wrists. Cellulitis (choice B) is a bacterial infection of the subcutaneous tissues, and causes local
erythema, tenderness, and often lymphangitis.
Lichen simplex chronicus (choice C) is a skin rash caused by chronic scratching characterized by
dry, scaling, well-demarcated, hyperpigmented plaques.
Nummular dermatitis (choice D) causes widespread coin-shaped, crusted skin lesions.