Hyperkeratosis, Papillomatous Plaques, and Loosely Adherent Crust on Legs

A 49-year-old woman with morbid obesity and hypertension presented with extensive areas of redness and weeping sores on her legs.

The physical examination of the lower extremities showed chronic changes of dependent edema with hyperkeratosis, papillomatous plaques, and loosely adherent crust and cobblestone-like nodules that extended to the thigh (inset).

What is the most likely cause of these skin changes?