Multiple plaques, slack skin, and ulcers

A 37-year-old man presented with a 12-year history of infiltrative plaques, skin laxity, and ulcers on his body. The physical examination revealed multiple infiltrative plaques, circumscribed red patches on his trunk and extremities, and several ulcers on his arms and lower back. There was a painful 20 cm × 25 cm ulcer on his left popliteal fossa with a necrotic base and a violaceous border. Loose skin masses involved his axillae and buttocks (Fig 1). Histopathology of the abdomen revealed a deep dermal infiltrate of atypical lymphocytes, scattered multinucleated giant cells, and a loss of elastic fibers.

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