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Last updated: September 24, 2025View editorial policy

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Differential Diagnosis for Bilateral Lower Leg Rash

Single Most Likely Diagnosis

  • Stasis Dermatitis: This condition is a common cause of rash on the lower legs, particularly in individuals with poor circulation or venous insufficiency. The burning pain and location of the rash above the ankles are consistent with stasis dermatitis.

Other Likely Diagnoses

  • Contact Dermatitis: This is a possible cause of the rash, especially if the patient has been exposed to irritants or allergens on their lower legs. The burning pain could be due to an allergic reaction or irritation.
  • Eczema (Atopic Dermatitis): Eczema can cause a rash on the lower legs, and the burning pain could be due to inflammation and skin barrier disruption.
  • Cellulitis: This is a bacterial infection of the skin that can cause a rash, redness, and pain on the lower legs. However, cellulitis typically presents with more pronounced signs of infection, such as fever and swelling.

Do Not Miss Diagnoses

  • Deep Vein Thrombosis (DVT): Although DVT typically presents with swelling, warmth, and pain in one leg, it is essential to consider this diagnosis due to the risk of pulmonary embolism. A rash on the lower leg could be a secondary sign of DVT.
  • Vasculitis: This is a group of conditions characterized by inflammation of blood vessels, which can cause a rash, pain, and other systemic symptoms. Vasculitis can be life-threatening if left untreated.

Rare Diagnoses

  • Erythema Ab Igne: This is a rare condition caused by prolonged exposure to heat, which can cause a rash and burning pain on the affected area.
  • Necrobiosis Lipoidica: This is a rare skin condition characterized by necrotic lesions and inflammation, which can cause a rash and pain on the lower legs.
  • Lichen Planus: This is a chronic inflammatory condition that can cause a rash, itching, and pain on the skin, including the lower legs. However, lichen planus is relatively rare and typically presents with more widespread skin involvement.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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