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Quiz Case

Ulcers and Stellate Scars on Bilateral Ankles

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A 75-year-old woman presented with a 2-year history of exquisitely tender ulcerations on her bilateral ankles, which caused pain with ambulation. She had a history of multiple miscarriages, a myocardial infarction at age 60 years, and hypertension. Physical examination revealed stellate purpuric macules, 2 areas of punched-out ulcerations, and 3 white stellate atrophic scars on the left lateral ankle (Figure 1). A 4-mm punch biopsy was obtained from the left lateral ankle (Figure 2 and Figure 3).

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Ashish Bhatia, MD, Web Editor, Archives of Dermatology.

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