Test your diagnostic skills in our regular dermatology quiz. What is the cause of this patient’s persistent leg ulceration and can it be adequately treated?
An 82-year-old man presents with persistent shallow ulceration of his lower right leg that has been present for three years (Figures 1a and b). It is moderately painful and has been recurrently infected. The patient has been treated with ulcer dressings and antibiotics with bed rest without improvement; skin grafting carried out a year ago also failed. The surrounding skin is dry, scaly and pigmented.
The patient is otherwise in good health. His pedal pulses are palpable. Diabetes has been ruled out and his skin sensation is normal.