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Antiphospholipid syndrome

An autoimmune disorder that can cause multiple, painful, 'punched-out' ulcerative lesions, often on the legs, due to thrombosis.

Atypical mycobacterial infection

Can cause multiple indolent nodules that break down to form chronic, ulcerative lesions.

Calciphylaxis

A condition of vascular calcification leading to multiple, intensely painful, necrotic ulcers with black eschars, typically in patients with renal failure.

Deep fungal infection

Disseminated fungal infections in immunocompromised hosts can cause multiple ulcerative or nodular skin lesions.

Degos disease

A rare vasculopathy causing multiple, distinctive skin lesions that start as pink papules and evolve into atrophic, porcelain-white scars with a telangiectatic rim.

Diabetes

Can cause multiple neuropathic ulcers on pressure-bearing areas of the feet, which are typically painless with a punched-out appearance and a callused rim.

Factitial ulcers

Self-inflicted ulcers that often have bizarre, geometric shapes and are found in locations accessible to the patient's hands.

Lucio's phenomenon

A rare reaction in lepromatous leprosy with widespread, polygonal, purpuric patches that become necrotic and slough off, leaving large ulcers.

Peripheral arterial disease

Arterial insufficiency causes painful, 'punched-out' ulcers with a pale base, typically on the toes and other distal locations.

Pyoderma gangrenosum

Presents as inflammatory papules or pustules that rapidly expand into multiple, painful ulcers with a distinctive violaceous, undermined border.

Venous insufficiency

Chronic venous disease is the most common cause of leg ulcers, typically located over the medial malleolus, with surrounding stasis dermatitis changes.

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