This presents as a waxy, atrophic, yellowish plaque with prominent telangiectasias, typically on the shins, a very different primary lesion than an ulcer.
The key differentiator is its location over a pressure point (e.g., sole of the foot) in a patient with sensory loss (neuropathy), and it is typically painless with a calloused border.
This is an inflammatory ulcer distinguished by its rapid expansion, violaceous (purple), undermined border, and extreme pain, often associated with systemic disease.
Distinguished by its location within the "gaiter area" (medial lower leg above the ankle) and the presence of surrounding signs of chronic venous insufficiency, such as edema and hemosiderin staining.
