Severe Bilateral Venous Stasis Ulcers (Picture).

A hospitalist reader sent me this picture of an  uncommon presentaion of a common disease:  severe bilateral venous stasis ulcers.  Welcome to hospitalist medicine.  Where severe cases like this is our normal bread and butter.  This is one case where bilateral cellulitis may actually apply.

Many patients I take care of are incapable of maintaining basic levels of personal care for any number of reasons.  They may be homeless.  They may be addicted to illicit drugs, alcohol or other prescription medications.  They may be experiencing severe depression or anxiety.  They may have schizophrenia, bipolar, obsessive-compulsive disorder or any other of a number of psychiatric conditions that prevent them from maintaining adequate self cares.

These  deficits may present as a lack of personal skin hygiene, washing and bathing skin and hair and  maintaining clean cloths free of putrid smells.  They may also fail to maintain a basic level of self awarness with regards to their medical condition.  I suspect that's the case in this pair of legs below.  This picture shows a severe case of bilateral stasis edema ulcers.  This is what happens when poor skin hygiene meets chronic leg swelling and failure to seek medical attention.  While time may heal many wounds, I have a sneaky suspicion that time is not going to heal all these wounds, as this medical someecard below so eloquently explains.

On the flip side, not all legs are swollen. Sometimes, they're just fat. Excuse me, I didn't mean to be offensive.  Sometimes they just have chronic static adipose deposits.