Skin lesions on legs: common causes

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Skin lesions that may occur on the legs

Eczema or atopic dermatitis

Eczema, also known as atopic dermatitis, is a skin condition that causes red, itchy and dry skin as a result of inflammation This condition is typically found in children but can continue into adulthood. Eczema symptoms include dry, scaly, thickened skin that is almost always itchy. It can often begin in the creases of the elbows and knees and can cover many areas of the body, including the legs.

Especially among darker-skinned people, eczema can cause skin discoloration, making the affected area lighter or darker than the surrounding skin. The cause of eczema is unknown but it is thought to be linked to allergies and asthma and is suspected to be an overactive immune response to an irritant.  While there is no cure for the condition, symptoms can be managed. For many people, eczema will even go away over time. Doctors can prescribe topical corticosteroid creams and ointments, oral medications and light therapy to help ease symptoms.

Varicose eczema

Varicose eczema, also known as venous eczema and gravitational dermatitis, is another form of eczema that results from swelling of veins, typically in the lower legs. It’s a long-term condition that usually affects older people and often takes a long time to heal.

The skin on the legs usually becomes red, scaly and flaky. Brown patches may also develop and the skin can feel hard or tight. It is thought to be caused by fluid collecting in the tissues. It can also be characterized by white irregular scars with red spots around them.

Contact dermatitis

Contact dermatitis is a form of eczema that occurs when the skin comes in contact with an irritant and forms a rash. The rash can be caused by an allergic reaction or simply a result of an irritating substance such as an acid or certain metals.

The rash will typically be red and itchy. Sometimes hives or blisters can form or the affected area can become flaky or scaly.

Read More: Skin Pigmentation: What it is and common disorders


Cellulitis is a bacterial infection of the skin that favors the lower legs. Common symptoms include redness, swelling, and tenderness of the affected area. The area can often look like a rash and it typically will feel warmer than other areas of the skin.

The infection can also affect the tissues underneath your skin and can spread to the lymph nodes and bloodstream if left untreated. It’s important to see a doctor immediately if you have a fever and if the rash is changing quickly. In most cases, the condition can be cured with antibiotics.


Folliculitis is an infection of the hair follicles. It is typically caused by irritation to the hair follicles from shaving or wearing tight clothes that rub against the skin.  This condition appears as swollen hair follicles that will often look like red pimples.

The follicles may itch, burn or become filled with pus or blood. This condition will usually clear on its own but in some cases, a doctor may prescribe an antibiotic.


This is a harmless condition that usually occurs on the lower legs and is thought to be a result of leaking capillaries (small blood vessels). Capillaritis will often flare back up throughout a person’s life. It appears as reddish-brown patches on the skin that can look like a rash or little bumps.

The condition will usually fade away on its own and there is no cure for the condition. There aren’t many helpful treatments but sometimes topical steroids will be prescribed to help with itching. Excessive exercise, viral infections, some food sensitivities, medications and standing for long periods of time are thought to trigger the condition.

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Lichen simplex

Lichen simplex is a localized form of eczema that results from repetitive itching, scratching or rubbing of an area. The initial itch can be caused by many things, from psoriasis to an insect bite, but lichen simplex occurs when the area becomes thickened and plaques begin to form.

Other symptoms include scratch marks, a scaly texture, broken hairs, and different pigmentation than the surrounding skin.

Nodular prurigo

Nodular prurigo is when itchy, hard lumps appear on the skin, especially on the legs. The lump is usually 1-3 cm in diameter and can have a wart-like texture. The lesion may start as a small red bump and can worsen over time, becoming crusty or scaly.

Eventually, the lesion may become darker than the surrounding skin and other prurigo lesions will group around the initial lesion. The condition usually begins on the lower arms and legs but other areas can also be affected. The exact cause of the condition is unknown but can usually be treated with emollients, Antihistamines, topical steroid creams, and other topical and non-topical mediations.

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Psoriasis is a chronic skin disease that causes red, scaly and itchy plaques to form on the skin. It is caused by skin cells multiplying faster than normal.

Psoriasis can also take the form of small red spots, pus-filled bumps, red patches that feel sore or as skin that becomes bright red and appears burnt.

It often occurs on the knees, elbows, and scalp, and, although it is incurable, it usually responds well to treatment.  Treatments include topical creams, medicines, ultraviolet light treatments and more.

Lichen Planus

Lichen planus is an inflammatory skin condition that occurs on the skin and mucosal surfaces. It is an autoimmune disease where an unknown protein in the skin and mucosal keratinocytes comes under attack by inflammatory cells.

Lichen planus can occur from a variety of reasons including stress, scratches to the skin, a viral infection or from certain drugs. The condition appears as papules and plaques that are shiny and have flat tops. Sizes can range and they can occur anywhere but are most frequently found on the wrists, ankles and lower back.

Many times the lesions are purple or violet in color. Treatment for this condition is not always necessary but when treatment is given it is usually in the form of topical or injected steroids, retinoids or other topical creams.

Many other skin conditions can cause leg lesions, so it’s always best to see your doctor at any sign of concern. For more information on possible causes, read our article on common skin lesions.

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"The melanoma could have been on my arm for years"
Andrew Bartlett
United Kingdom

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