A 55-year-old-woman was admitted to the hospital to rule out bilateral lower extremity cellulitis. She presented with lower extremity edema and sharply demarcated pretibial erythema that extended just above the medial malleolus bilaterally (Figure 60-1). She was afebrile, and complete blood count (CBC) was within normal limits. The patient was diagnosed with classic stasis dermatitis, a condition commonly misdiagnosed as bilateral lower extremity cellulitis.
Lower extremity edema and pretibial erythema consistent with stasis dermatitis. This is commonly misdiagnosed as bilateral lower extremity cellulitis.
The prevalence is estimated to be greater than 1% of the population.1
Slight female preponderance reported.1
Prevalence increases with age.
ETIOLOGY AND PATHOPHYSIOLOGY
Clinical Features of Stasis Dermatitis
Often first manifests as lower extremity edema.
Scaling, xerosis, and pruritus are often present within the mid and distal medial calf (Figure 60-2). Less often, similar manifestations affect the lateral calf.
Hemosiderin deposition often leads to the classic brown discoloration seen in stasis dermatitis (Figure 60-3).
Erythema, scaling, and diffuse dermatitis can result in a weepy appearance with oozing and crusting (Figure 60-4).
When stasis dermatitis is present chronically, fibrosis of the underlying tissues progresses to lipodermatosclerosis.
A constricting band forms around the distal calf causing the classic "inverted wine bottle appearance" of the lower extremity (Figure 60-5).
Chronic stasis dermatitis can also present with violaceous papules, plaques, and nodules mimicking Kaposi sarcoma. This entity is known as pseudo-Kaposi sarcoma or acroangiodermatitis.2
Scaling, xerosis, and pruritus are often present in the medial lower ...
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