Cutaneous Manifestation of Hepatitis C

Resource: http://emedicine.medscape.com/article/1134161-overview
http://www.medscape.com/viewarticle/548006_4

I have seen a patient today with a history of Hepatitis C. The lesion is located inferior to the right medial malleolus. Itchiness and clear discharge due to scretching of lesion was mentioned by patient. No obvious erythema noted except for some purpura over the skin.

Differential Diagnosis:
1) Prurigo nodularis
2) Acral necrolytic erythema
3) Cryoglobulinemia (Leukocytoclastic vasculitis)
4) Erythema nodosum
5) Erythema multiforme
6) Porphyria Cutanea Tarda (Least likely due to the fact that it required sunlight to cause symptom)