Chronic Reddish-Brown Pigmentation on Lower Extremities in a Healthcare Worker

Case at a Glance

A 30-year-old male registered nurse presents with chronic reddish-brown discoloration on the dorsal aspect of feet, ankles, and lower shins, accompanied by a rough patch on the posterior left calf. The condition has persisted for several years with intermittent fluctuation in appearance.

Patient's Story

The patient reports a several-year history of reddish-brown areas and dots affecting the tops of his feet, ankles, and lower shins. He describes the lesions as waxing and waning in appearance but never completely resolving. The affected skin feels normal to touch and is completely asymptomatic - no pain, pruritus, or burning sensation. Recently, he has also noticed a rough-textured patch on the back of his left calf that remains persistently present without associated discomfort. As a healthcare professional, he has been monitoring these changes but decided to seek medical evaluation due to their persistent nature.

Initial Assessment

Physical examination reveals multiple reddish-brown macules and patches distributed over the dorsal feet, ankles, and anterior lower legs bilaterally. The lesions appear to be primarily pigmentary with no elevation, scaling, or other surface changes. A separate rough-textured plaque is noted on the posterior aspect of the left calf. The patient is a non-smoker and non-drinker with an otherwise unremarkable social history.

The Diagnostic Journey

The patient has been evaluated by multiple specialists including cardiology, psychiatry, and oncology as part of his ongoing healthcare. Laboratory studies consistently show normal values except for chronically mildly decreased platelet count. Differential diagnoses being considered include venous insufficiency, capillaritis, chronic pigmented purpura, or other causes of lower extremity pigmentation. The patient questions the possibility of venous insufficiency and seeks further clarification on diagnostic workup.

Final Diagnosis

Pending dermatological evaluation. Working differential includes chronic pigmented purpura (capillaritis), early venous stasis dermatitis, or idiopathic hemosiderin deposition.

Treatment Plan

Referral to dermatology for specialized evaluation and possible biopsy if indicated. Consider Doppler ultrasound of lower extremities to evaluate for venous insufficiency. Continue monitoring of platelet levels given chronic mild thrombocytopenia.

Outcome and Follow-up

Patient scheduled for dermatology consultation. Plans for photographic documentation and potential histopathological examination pending specialist evaluation. Long-term monitoring recommended given chronic nature of condition.