Lipodermatosclerosis

QUESTION 30

A 54-year-old woman presents to the dermatology clinic as a referral from her primary care physician for evaluation of painful induration and hardening of the skin on her lower legs bilaterally. She has a medical history notable for obesity, coronary artery disease, type II diabetes mellitus, peripheral neuropathy and chronic venous insufficiency. She has been treated with two courses of systemic antibiotics for cellulitis of the lower legs but notes no improvement in her symptoms. On examination, there is localized, well-demarcated induration with some sclerotic changes and associated hyperpigmentation affecting the distal medial leg above the malleolus (30).