Patient of Dr 

60 Years old lady presented with rapid onset ( 24 hours) of this cellulitis on her left lower leg.
she is very obese she is not diabeteic, the leg is very tender.

i saw this lady while doing locum at a small rural town.

i sent her to the base hospital and they start some IV ABS, however her cellulitis become worse and has to transfere her to regoinal hospital the next day.
the "black area " on the image become more extensive the next day.

With that build if she is not diabetic she soon will be! This appears to be a necrotising cellulitis. You should always check the sensation in the dark area because if impaired it may be a necrotising fasciitis which will require surgery. Lipodermatosclerosis causes an hour glass deformity of the lower leg which this lady seems to have. It can be due to chronic venous insuuficiency but also to some vascular clotting enzyme abnormalities causing microvascular damage with resultant sclerosis. (Submitted By: Dr Ian McColl)