A 62-year-old female presents with a non-healing ulcer on the medial aspect of her lower calf, superior to the medial malleolus. The surrounding skin displays brown hemosiderin hyperpigmentation, induration (lipodermatosclerosis), and varicosities. The ulcer base is moist with irregular margins and painless. What is the underlying etiology?

Answer and explanation

Correct answer: D. Chronic venous insufficiency (venous stasis ulcer)

  1. Step 1: Analyze ulcer location and morphology: Medial gaiter area (above medial malleolus), shallow irregular borders, copious exudate, and hemosiderin staining.
  2. Step 2: Identify pathophysiology: Ambulatory venous hypertension causes capillary distension, fibrin cuff formation, and red cell extravasation.
  3. Step 3: Conclude diagnosis: Venous stasis ulceration.
Answer
Chronic venous insufficiency (venous stasis ulcer).
Why not the others: 'Arterial ulcers' occur over distal pressure points (toes, heel, lateral malleolus), are deeply painful, dry, with 'punched-out' borders and absent pulses; 'Neuropathic ulcers' occur on plantar weight-bearing pressure areas; 'Pyoderma gangrenosum' presents with violaceous undermined borders.

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