Limb examination - continued
- Atrophie blanche. white areas of decreased capillary density (ischaemic skin), that can be painful and herald the site for future ulceration
- Venous eczema is idiopathic and presents as itchy, erythematous, weeping and scaled areas of skin that may be painful. Venous eczema can be wet or dry and can be misdiagnosed as cellulitis. Please note bilateral cellulitis is a very rare event and is frequently misdiagnosed when the patient is actually presenting with bilateral infected varicose eczema
NB: all the above contribute to skin fragility and increased risk of leg ulceration and delayed healing.
Lipodermatosclerosis can be present without ulceration and in this situation preventative compression hosiery should be prescribed. This highlights the need to assess both lower limbs rather than just the one with the ulceration.