A 48-year-old obese man1 with a history of hypertension, coronary artery disease, and status post鈥搎uadruple bypass presented with an 8-month history of painful ulceration on the right midback. The initial lesion was described as a 4-cm square area of eroded eczematous dermatitis, which later developed 2 areas of ulceration that worsened despite various treatments, including oral and intralesional corticosteroids, oral antibiotic agents (erythromycin and ciprofloxacin), dapsone, and a hydrocolloid dressing.