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Clinical Images  |   August 2016
Mistaken Lower Extremity Dermatitis
Author Notes
  • From the Department of Family Medicine at the Grafenwoehr Army Health Clinic in Germany (Dr Noss) and the Naval Medical Center Portsmouth Joel T. Boone Branch Health Clinic in Virginia Beach, Virginia (Dr Neamand-Cheney). 
  •  *Address correspondence to Matthew R. Noss, DO, MSEd, CMR 415 Box 6365, APO AE 09114-0064. E-mail: mnoss@vcom.vt.edu
     
Article Information
Cardiovascular Disorders / Imaging / Neuromusculoskeletal Disorders / Pain Management/Palliative Care / Clinical Images
Clinical Images   |   August 2016
Mistaken Lower Extremity Dermatitis
The Journal of the American Osteopathic Association, August 2016, Vol. 116, 552. doi:10.7556/jaoa.2016.109
The Journal of the American Osteopathic Association, August 2016, Vol. 116, 552. doi:10.7556/jaoa.2016.109
An 81-year-old man presented to the family medicine clinic with a complaint of several months of redness and inflammation on his left lower extremity. The lesion appeared after the patient received a diagnosis of deep vein thrombosis about 5 months before the current presentation. The patient received a diagnosis of cellulitis 3 to 4 weeks later and oral antibiotics were prescribed, but they provided no relief. At the current presentation, the patient’s vital signs were normal. Physical examination revealed large, blanching, erythematous plaques that started distal to the knee and tapered at the ankle. The skin was warm and indurated, but not edematous or tender. The skin was hard and had a scaly appearance. Laboratory test results were normal, except for a minimally elevated erythrocyte sedimentation rate. Dermatitis was diagnosed, and the patient was treated with daily Eucerin (Beiersdorf Inc), leg elevation, and compression stockings. 
Inflamed or eczematized stasis dermatitis is often misdiagnosed as cellulitis. It results from venous stasis from chronic venous insufficiency and is characterized by dry, erythematous, scaling skin often overlying superficial varicose veins.1 Presentation may include dull aches in the lower extremity, edema alleviated by elevation, eczematous changes of the surrounding skin, and varicosities.2 Treatments include daily hydration, a short course of a topical steroid, leg elevation, and graded compression stockings. 
References
Trayes KP, Studdiford JS, Pickle S, Tully A. Edema: diagnosis and management. Am Fam Physician. 2013;88(2):102-110. [PubMed]
Collins L, Seraj S. Diagnosis and treatment of venous ulcers. Am Fam Physician. 2010;81(8):989-996. [PubMed]