White scars over the ankle

Over a three-year period, a 54-year-old man developed patchy white scars over his medial left ankle. The white patches had a prominent, nonpalpable, red, punctate element (Figure 1). The ankle was swollen by the end of each day. Varicosities were evident over the medial ankle and the calf. Small ulcers had previously developed over the ankle, and had spontaneously healed. A skin biopsy of one of the ulcers demonstrated an eschar under which there were clusters of small venules separated by interstitial fibrosis, haemorrhage and haemosiderosis. Some of the vessels had a prominent pericapillary fibrin cuff (Figure 2).