Differential Diagnosis for 44 YR OLD MALE WITH DISCRETE PURPLISH ELEVATED LESIONS RT LOWER LEG 3X3 CMS WITH ITCHINESS
- Single most likely diagnosis
- Lichen simplex chronicus: This condition is characterized by thickened, hyperpigmented skin lesions that are often itchy, which fits the patient's symptoms. The location on the lower leg is also common for this condition.
- Other Likely diagnoses
- Eczema (atopic dermatitis or nummular dermatitis): Eczema can cause itchy, elevated lesions, and the lower leg is a common location. The purplish color could be due to scratching or chronic inflammation.
- Insect bites or contact dermatitis: These conditions can cause itchy, elevated lesions, and the lower leg is a common location due to exposure. The purplish color could be due to an allergic reaction or inflammation.
- Psoriasis: While less common on the lower leg, psoriasis can cause itchy, elevated lesions. The purplish color could be due to inflammation or trauma to the lesions.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Malignant melanoma: Although less likely, any new or changing skin lesion, especially with an unusual color, should be evaluated for melanoma due to its high mortality rate if left untreated.
- Deep vein thrombosis (DVT) with associated skin lesions: While DVT typically presents with swelling, warmth, and pain, it can occasionally cause skin lesions or discoloration. Given the potential for severe complications, including pulmonary embolism, it's crucial not to miss this diagnosis.
- Rare diagnoses
- Kaposi's sarcoma: This rare cancer can cause purplish skin lesions, especially in immunocompromised patients. It's less likely but should be considered, especially if the patient has a history of immune system suppression.
- Erythema elevatum diutinum: A rare skin condition characterized by purplish-red lesions, often on the lower extremities. It's associated with various systemic diseases and infections, making it an important, though rare, consideration.