Erosive Papulonodular Dermatosis of the Lower Extremities: A Reactive Change in the Setting of Chronic Lymphedema

Erosive papulodnodular dermatosis (EPD) is classified as an inflammatory cutaneous eruption secondary to a chronic, external irritant [1,2]. Treatment for EPD focuses on eliminating the presumed irritant [2] and preventing secondary bacterial infection [1,3]. We present a case of EPD, secondary to inflammation from lymphatic stasis, refractory to medical and antimicrobial treatment. Given the recalcitrant nature, sharp surgical debridement followed by Unnaboot application, significant diuresis and weight loss resulted in remarkable improvement. We report an instructive case of erosive papulonodular dermatosis secondary to inflammation associated with lymphatic stasis to alert clinicians of this rare presentation and causative agent. Further, this case warrants discussion regarding surgical therapy as a potential adjunctive therapy to accelerate healing in EPD.