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Bilateral lesions on the legs

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A 50-year-old woman came to the office for medical advice regarding bilateral erythematous lesions on the inner aspects of both of her legs. She had been aware of the lesions for more than 5 months. She had no other medical complaints, and was not taking any prescribed, over-the-counter, or herbal medications, or using any moisturizers or other medicated topical preparations. She mentioned that she was using a hot water bottle on her legs to keep her warm.

On physical examination, we noted bilateral erythema in a mesh-like distribution on her frontal, inner lower thighs as well as the upper and medial aspects of her calves. There were prominent telangiectatic vessels and “spider veins” surrounding the erythema, but her skin was otherwise normal. The review of her systems showed no problems. Personal and family histories were not contributory.

Lesions on the legs

Mottled or mesh-like pigmentary changes on the legs of a 50-year-old woman.

Skin biopsy revealed subepidermal separation accompanied by thinning of the epidermis with loss of rete ridges and the presence of dermal edema. There was an increase in the number of elastic fibers with aberrant disruption. Perivascular infiltration of inflammatory cells was also noted.


Close-up of figure 1, showing the telangiectatic vessels and spider veins around the erythema.

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