Discoloration of lower legs
A 47-year-old man asked his doctor to take a look at the brown color that had been staining his feet and lower legs over the past 2 years. He denied any associated symptoms or known precipitating events. Close-up examination of the skin revealed small brown and pink dots within the skin. There were no palpable abnormalities. Other than a mildly elevated blood pressure and probable onychomycosis, the remainder of the physical exam was normal. The patient denied leg edema and there was no peripheral edema on exam.
What's your diagnosis?
The family physician diagnosed Schamberg’s disease based on the hemosiderin deposits and a cayenne pepper appearance. Schamberg’s disease is a capillaritis characterized by extravasation of erythrocytes in the skin with marked hemosiderin deposition.
There is no known effective treatment for Schamberg's disease. Topical corticosteroids have been tried, but with little success. Patients can be reassured that the condition is harmless and is only a cosmetic concern. The patient was reassured by this information and did not want to try topical steroids.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Mayeaux EJ, Usatine R. Cutaneous vasculitis. In: Usatine R, Smith M, Mayeaux EJ, et al., eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:760-765.
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