This patient has stasis dermatitis. Stasis dermatitis, especially in the acute setting, can present with brightly erythematous, edematous plaques, as shown in the figure, that are tender to palpation and can be slightly warm to touch. Overlying scale and serum crust also can develop as a consequence of fluctuating edema (as seen in the figure). Differentiating stasis dermatitis from cellulitis can be difficult; however, the presence of similar-appearing erythematous plaques bilaterally in an afebrile patient with no lymphadenopathy or other symptoms or signs of infection would be unusual for cellulitis. Because stasis dermatitis usually results from decreased venous drainage or excess fluid in dependent areas causing increased vascular permeability and stretching of the skin, the clinical scenario of a patient with heart failure who has recently stopped taking a diuretic also is supportive of a diagnosis of stasis dermatitis. Chronic stasis dermatitis will cause more brown discoloration, suggesting a longer term process, but acute stasis dermatitis can present as bright red patches/plaques. Treatment typically includes optimization of volume status or external compression stockings to decrease fluid volume and skin stretching in dependent areas.
Cellulitis presents as a painful, erythematous, well-demarcated patch that is warm to touch. The presence of fever, lymphadenopathy, or other evidence of infection, such as an elevated leukocyte count, also would suggest this diagnosis. It is important to consider alternative diagnoses when there are erythematous patches on both legs.
Contact dermatitis may present with localized inflammation at the site of exposure to an irritant and may cause erythema and edema. However, it is often pruritic and may be accompanied by bullae and oozing. Contact dermatitis may also be preceded by a history of application of a sensitizing agent in the area.
Deep venous thrombosis can present as a swollen, erythematous leg. Although bilateral deep venous thromboses can occur, this is a less likely cause in this patient.
