Francis Christian, MD

Can you identify the cause of the hyperpigmented umbilicated lesions seen bilaterally on the patient's extremities and on her back?

The rapidly expanding lesion began as a small boil in the center of the ulcerated area 4 weeks ago. What underlying process do you suspect?

The lesions may mimic infectious, vascular, inflammatory and other ulcers; they do not respond to antibiotics and debridement often exacerbates the ulcer.