School of Podiatric Medicine Publications
Document Type
Poster
Publication Date
9-26-2026
Abstract
Introduction: Port-wine stains are congenital capillary malformations that may occur in isolation or with underlying vascular and musculoskeletal abnormalities in various syndromes. Chronic ulceration and inflammatory skin changes may complicate diagnosis and management, particularly when atypical ulcer morphology is present.
Aim: To describe complex lower extremity ulceration and inflammatory skin disease in a patient with a large congenital port-wine stain and associated limb abnormalities.
Case Presentation: A 52-year-old White male with a congenital port-wine stain involving the lateral left lower extremity from the hip to the foot was evaluated for recurrent ulceration and progressive inflammatory skin changes. Associated findings included limb length discrepancy, calf hypotrophy, and progressive ipsilateral foot drop requiring an ankle-foot orthosis (AFO). He presented with recurrent medial and lateral ankle ulcerations and worsening bullous eruptions of the lateral calf. Arterial and venous studies were unremarkable. Biopsies of the leg and ankle ulcer were obtained to evaluate for inflammatory or neutrophilic dermatoses.
Results: Biopsies demonstrated non-specific epidermal spongiosis and acanthosis with stasis-related changes. Serpiginous inflammatory borders raised concern for atypical ulcer pathology, including pyoderma gangrenosum. The patient tolerated mild compression with an Unna boot with serial application treatments. Both ankle ulcers healed within approximately two months. At most recent follow-up, residual leg ulcers measured approximately 1×1cm.
Conclusions: This case highlights the diagnostic and therapeutic complexity of ulceration and inflammatory skin disease in the setting of congenital vascular malformation. A lifelong, previously stable congenital lesion evolved into a painful and clinically suspicious ulcerative process that remained diagnostically challenging despite specialist evaluation and repeat biopsies. Biopsy findings supported stasis-related inflammatory changes rather than a primary neutrophilic dermatosis. Structural abnormalities, neuropathy, and possible pathergy may contribute to impaired healing. Individualized mild compression may be better tolerated and support healing when standard compression is poorly tolerated.
Recommended Citation
Killeen, Amanda L.; Heybeck, Tyreen; Higham, Michael; and Campbell, Stephanie N., "Complex Wound Presentation in a Congenital Port Wine Stain: Venous Ulceration or Inflammatory Dermatosis?" (2026). School of Podiatric Medicine Publications. 144.
https://scholarworks.utrgv.edu/sopm_pub/144
Academic Level
faculty
