Rashes affecting the lower legs

Dermatitis

Most often, a rash affecting the lower legs is a type of dermatitis. The terms ‘dermatitis’ and ‘eczema’ are often used interchangeably. Acute dermatitis presents as red, swollen and blistered plaques. Chronic dermatitis accompanied by rubbing and scratching results in darkened (hyperpigmented), and thickened (lichenified) plaques.

There are several different types of lower leg dermatitis:

• Atopic dermatitis
• Discoid eczema
• Varicose dermatitis
• Gravitational dermatitis
• Contact dermatitis
• Autonomic denervation dermatitis
• Lichen simplex
• Pretibial pruritic papular dermatitis
• Prurigo nodularis

Atopic dermatitis 

Discoid eczema 

Varicose dermatitis 

Gravitational dermatitis 

Contact dermatitis 

Lichen simplex 

Prurigo nodularis 

Scaly rashes of the lower legs

Scaly conditions affecting the lower legs include:

• Psoriasis
• Lichen planus
• Superficial basal cell carcinomas

Psoriasis 

Lichen planus 

Superficial basal cell carcinomas 

Infections favouring the lower legs

• Cellulitis
• Folliculitis
• Tinea corporis

Cellulitis 

Folliculitis 

Tinea corporis 

Redness of the lower legs

Other red or purplish conditions favouring the lower legs include:

• Pretibial myxoedema
• Panniculitis
• Necrobiosis lipoidica
• Vasculitis
• Capillaritis

Pretibial myxoedema 

Panniculitis 

Necrobiosis lipoidica 

Vasculitis 

Capillaritis 

Lower leg ulcers

• Detailed descriptions of leg ulcers
• Differential diagnosis of leg ulcers

Leg ulcers 

Management of lower leg rashes

Management depends on making a correct diagnosis. General advice should include:

• Avoid and treat dry skin, using non-soap cleansers and thick simple emollients. Avoid exposing the legs to direct heat or the hot air of the heater in a car.
• Minimise swelling – avoid standing for prolonged periods, take regular walks, elevate the feet when sitting or overnight and wear special graduated compression stockings long term.
• Prescription treatments may include oral antibiotics for secondary infection and topical steroids of varying potency – weak products can be used long term if necessary but potent topical steroids should be used once or twice daily for short courses of one to four weeks.

Avoid topical antibiotics, topical antihistamines and multi-ingredient fragranced or herb-containing emollients because of the risk of provoking contact allergy.