This is the ulcer of a 55 year old man who has had diabetes for 14 years. It started when he scratched his leg during a construction project 6 months earlier. You can see from the photo of his leg that he has almost no edema, no hemosiderin, and no lipodermatosclerosis. He actually has 2 ulcers. The pain from them is incapacitating. Biopsy showed “stasis changes.” The lesions did not respond to Prednisone, Dapsone, Levaquin, Doxycycline, or topical Tacrolimus.
What do you think he has?
Eventually we decided he might have atrophie blanche and he was put on Enoxaparin. He took it briefly during which time the lesions started healing, but stopped. Because the biopsy was read as “stasis,” the dermatologist sent him for venous ablation and the vein doctor told him he’d benefit from venous ablation. What do you think?