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INTRODUCTION TO CHAPTER

The legs are predisposed to dermatoses that are gravity dependent, including stasis dermatitis and vascular conditions such as leukocytoclastic vasculitis, the pigmented purpuric dermatoses, and livedo reticularis. Legs are also the site of frequent trauma and thus are susceptible to conditions that may be induced by trauma including superficial thrombophlebitis, pyoderma gangrenosum, necrobiosis lipoidica, chronic ulcers, and cellulitis. In patients with preexisting vascular conditions affecting the lower extremities, including diabetes mellitus, venous insufficiency, and peripheral vascular disease, traumatic wounds may take longer to heal and may have an increased risk of infection.

APPROACH TO DIAGNOSIS

Skin diseases primarily involving the legs can be broadly categorized into inflammatory conditions, infectious diseases, superficial vascular disorders, neoplastic lesions, and underlying systemic diseases (see Table 35-1). Differentiating between these conditions can usually be done based on an appropriate history and physical examination. Occasionally, dermatitis on the lower extremities may be difficult to distinguish from a cellulitis. Cellulitis of the lower extremities tends be unilaterally, as compared to dermatitis, which usually is bilateral.

Table 35-1.Differential diagnosis for diseases of the legs.

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