A woman in her 30s presented to the dermatology clinic for evaluation of discoloration on the lower extremities. She first noticed the lesions on her feet 16 years prior, which progressively spread to her lower legs. Areas of involvement were initially pruritic, but these symptoms resolved over time. She denied accompanying claudication, pain, tingling, or numbness. She reported a history of Raynaud syndrome; however, she denied a personal or family history of autoimmune disease or coagulation disorders. Her history was also negative for urticaria, epistaxis, hemoptysis, hematochezia, coagulopathy, or abdominal pain. Results of a complete blood cell count, comprehensive metabolic panel, and venous duplex ultrasonography of the lower extremities previously completed by her primary care physician did not reveal any abnormalities. On examination, she had symmetrically distributed red to violaceous fine telangiectasias in a lacelike pattern on the dorsal feet and ankles (Figure), as well as the shins and calves. Her history and physical examination findings supported the diagnosis of generalized essential telangiectasia.