A 54-year-old woman presents with a 6-month history of bilateral, painful reddened lower legs. She reports that her legs feel tight. She has been hospitalized on 3 occasions for recurrent cellulitis of the legs. She notices that her legs improve when she is in the hospital but soon become red again after discharge.

On examination, she is obese. Both legs are affected from the knees downward. Circumferentially, the skin is red, feels slightly warm to the touch, and is indurated.