77-year-old male w/ HTN, DM,  hyperlipidemia, dementia presents w/ “feeling cold”. During examination I  noticed his lower leg looks like the picture shown above. When I asked him about it, he said it was always like that and that it does not bother him in any way.

What can be the diagnosis? Is it due to any peripheral arterial or venous disease or the consequence of untreated varicose vein?